Results from the randomized IMPACT trial (ClinicalTrials.gov identifier: NCT04095234) showed that acupuncture and massage reduced pain and improved fatigue, insomnia, and quality of life over 26 weeks. Of note, no significant differences between treatments were observed.
However, further research is essential to optimally incorporate these methods into pain treatment, with the aim of enhancing symptom management for the increasing number of patients with advanced cancer. These results are JAMA network open.
The purpose of the IMPACT trial was to evaluate the effects of acupuncture and massage on musculoskeletal pain in patients with advanced cancer for a comparative analysis.
The primary endpoint of the IMPACT trial was change in pain intensity scores between the initial assessment and after 26 weeks. Secondary endpoints were fatigue, insomnia, and quality of life. The primary outcome was assessed using the Brief Pain Inventory, which assessed intensity with a score from 0 to 10, with higher scores indicating increased pain intensity or interference.
A total of 298 participants with a mean age of 58.7 years (SD, 14.1) were enrolled, including 200 women (67.1%), 33 black patients (11.1%), 220 white patients (74.1%), and Hispanic patients. There were 46 people (15.4%) who were of this type. Patients; 78.5% of all patients had solid tumors.
The mean worst pain score at baseline was 6.9 (SD, 1.5). Over 26 weeks, deaths with the worst pain score on the Brief Pain Inventory were associated with acupuncture (mean change, -2.53 points, 95% CI, -2.92 to -2.15) and massage (mean change, -3.01 points, 95 % CI, -3.38 to -2.63) group.
However, the difference between the two groups was not statistically significant (-0.48; 95% CI, -0.98 to 0.03; P =.07). Both treatments resulted in improvements in fatigue, insomnia, and quality of life, with no notable differences between groups. Mild adverse events such as bruising (6.5% in the acupuncture group) and temporary pain (15.1% in the massage group) were reported.
The IMPACT trial had several limitations. There was no control group, which made it difficult to assess the specific impact of the intervention. Due to the nature of the intervention, both clinician and patient were not blinded. Although the study duration was the same between treatment groups, massage therapists had more clinician-patient interactions. The improvement in pain may be due to non-interventional effects. Additionally, the COVID-19 pandemic has disrupted treatment for some patients. Finally, the rigorous training of therapists for this study may limit generalizability to community settings where clinical care is diversely provided.
“Given that patients with advanced cancer often experience pain in multiple areas due to their disease or oncological treatment, promoting fair and effective pain management in cancer patients requires the use of massage as well as other pain treatments. Medicare coverage needs to be expanded to include other areas of cancer. Further educational efforts should also be directed toward training acupuncturists and masseuses in safe and effective treatments for patients with advanced cancer. the authors pointed out.
reference
Epstein AS, Riou KT, Romero SAD, et al. Acupuncture and massage for pain in patients with advanced cancer: the IMPACT randomized clinical trial. JAMA Net Open. 2023;6(11):e2342482. doi:10.1001/jamanetworkopen.2023.42482
