Pain management in cancer can be complex, with breakthrough pain occurring as the disease progresses. Pain can also be experienced after cancer treatment, even in those who are in remission. Acupuncture offers an effective non-malignant pain management option for some patients, although the applicability of this treatment is undetermined in cancer survivors who experience chronic pain. The Personalized Electroacupuncture vs Auricular Acupuncture comparativeness Effectiveness (PEACE) trial is a randomised trial assessing this treatment modality in this setting. This study enrolled 360 patients with a previous cancer diagnosis but no evidence of current disease, who reported musculoskeletal pain for at least 3 months. Patients were randomised 2:2:1 to receive electroacupuncture (N= 145), auricular acupuncture (N= 143) or usual care (N= 72). Patients receving acupuncture did so via 10 weekly sessions, with 10 sessions of acupuncture also offered to ‘usual care’ patients from weeks 12 through 24. The primary outcome of this trial was average change in BPI pain score from baseline to week 12.
The median age of patients in this trial was 62 years of age, with 69.7% being women. Among the entire cohort, the average BPI pain score at baseline was 5.2 points. Compared to the usual care, both forms of acupuncture reduced pain severity at 12 weeks, although electroacupuncture was the more successful of the two, reducing pain by 1.9 points (P< 0.001). In comparison, auricular acupuncture reduced pain by 1.6 points (P< 0.001). Furthermore, although mild, auricular acupuncture resulted in more patients experiencing adverse events compared to electroacupuncture. This was reflected in a higher rate of treatment discontinuation with auricular acupuncture compared to electroacupuncture (10.5% vs. 0.7%, P< 0.001).
This trial demonstrated the applicability of acupuncture to manage chronic musculoskeletal pain in cancer survivors. Specifically, electroacupuncture was found to be more efficacious in this setting compared to auricular acupuncture, resulting in a greater reduction in pain, less adverse events and fewer treatment discontinuations.
Mao J et al., Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors: The PEACE Randomized Clinical Trial. JAMA Oncol. 2021. [epub].