In a recent clinical trial published in JAMA network open, United States (USA) researchers evaluated and compared the effectiveness of acupuncture and massage therapy for musculoskeletal pain in 298 patients with advanced cancer. They found that both treatments could reduce patients’ pain, fatigue, and insomnia while improving their quality of life (QoL) over 26 weeks.
Research: Acupuncture and massage for pain in patients with advanced cancer. Image credit: Bjoern Wylezich / Shutterstock
background
The QoL of approximately 67% of patients with advanced cancer is hampered by pain, which is a debilitating symptom that is often accompanied by fatigue and insomnia. Treatment of pain in these patients primarily relies on the use of opioids, but the ongoing opioid crisis has limited the prescription and availability of these drugs. Furthermore, the potential side effects of such drugs highlight the increasing need and priority of alternative therapies for pain management.
2022 guidelines from the American Society of Clinical Oncology and the Society for Integrative Oncology recommend the use of acupuncture and massage for tumor pain management. Although there is evidence that acupuncture is effective in treating pain in cancer survivors, there is a lack of studies specifically conducted in patients with advanced cancer. The long-term benefits of massage in cancer pain management have also not been well investigated or compared to acupuncture.
Given that advances in cancer treatments have increased life expectancy, health care professionals need to make evidence-based and informed decisions about the possibility of integrating non-drug therapies to manage their patients’ pain. must be lowered. To address this need, researchers in this study conducted a randomized clinical trial to evaluate and compare the long-term effectiveness of massage and acupuncture in treating pain, fatigue, and insomnia in patients with advanced cancer. carried out.
About research
The IMPACT trial (short for Integrative Medicine Trial for Pain in Patients with Advanced Cancer) is a multicenter, two-arm, pragmatic parallel-group randomized clinical trial. Patients with various forms of advanced cancer (stage III or IV) or unresectable cancer must be 18 years of age or older, have a Karnofsky index of 60 or higher, be fluent in English or Spanish, and have a clinician’s estimated life expectancy of 6. Included in case of months. that’s all. Most importantly, included patients had local or generalized musculoskeletal pain (as their primary pain) for at least 1 month and had self-rated worst pain intensity. That she was 4 or older.Patients with platelet count less than 150 x 109/litre is excluded.
A total of 298 patients with a mean age of 58.7 years participated in the study, of whom 67.1% were female. The mean time since diagnosis was 5.6 years, and the mean duration of pain was 3.8 years. Approximately 78.5% of patients had solid tumors, and 54.7% of patients were receiving pain medications. Patients were randomized in a 1:1 ratio to receive either acupuncture (n = 150) or massage (n = 148) by a licensed therapist with oncology experience.
Patients reported outcomes at weeks 0, 4, 10, 14, 18, 22, and 26. The primary outcome was measured via the Brief Pain Inventory (BPI) on a scale of 0 and as the worst pain intensity in the previous week. Similarly, her co-occurring symptoms and health-related QoL were measured using the Brief Fatigue Inventory, the Insomnia Severity Index, and the Patient-Reported Outcomes Measurement Information System scale.
Acupuncture involves inserting 10 to 20 needles (at appropriate depths) in four or more localized points around the most painful areas of the body for approximately 20 minutes. The needle was manipulated to achieve local pain and dilatation (de qi), and effective needling was demonstrated. For patients without implanted electrical medical devices, 2 Hz electrical stimulation was applied.
Massage therapy began with 5 minutes of guided diaphragmatic breathing, occipital release, and rib mobilization, followed by a 20-minute massage of the chest, working toward key pain areas and the heart. Mild to moderate pressure is applied, muscle release, compression, stretching after isometric stretches, active/passive range of motion, thorax, and various releases (fascia, location, and trigger points). The techniques involved were performed.
Statistical analysis included the use of linear mixed models, least squares means, and Cohen’s decision. d Values with sensitivity analysis.
Results and discussion
At the end of 26 weeks, more than 50% of patients who received acupuncture or massage therapy had a clinical response. Compared to baseline, patients who received acupuncture or massage showed lower BPI worst pain scores, fatigue, insomnia, less dependence on painkillers, and improved QoL. No significant difference in the effectiveness of the two treatments was observed. The most common side effects of massage were temporary pain and headache, while those of acupuncture were bleeding, localized pain, and bruising.
However, this study is limited by the lack of a placebo or control, lack of blinding of clinicians or patients, and lack of generalizability to the community.
conclusion
The results of this study provide valuable evidence of the long-term effectiveness of acupuncture and massage in reducing pain and related symptoms in patients with advanced cancer, and as an integrative treatment to improve patient outcomes. shows the potential benefits of
