Bao, T., Cai, L., Giles, J.T., Gould, J., Tarpinian, K., Betts, K., . . . Stearns, V. (2013). A dual-center randomized controlled double blind trial assessing the effect of acupuncture in reducing musculoskeletal symptoms in breast cancer patients taking aromatase inhibitors. Breast Cancer Research and Treatment, 138, 167–174.

To evaluate the effect of acupuncture on function and pain in women with aromatase inhibitor associated musculoskeletal symptoms (AIMSS) and the effect of serum hormones and proinflammatory cytokines to help clarify the molecular mechanism of action with the use of acupuncture

Patients were randomized to eight weekly real or sham acupuncture sessions evaluated by the Health Assessment Questionnaire Disability Index (HAQ-DI) and pain visual analog scare (VAS) at baseline and after intervention. Serum hormones and proinflammatory cytokines were measured pre- and post-intervention.

• N = 47  
• AGE = 44–85 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Postmenopausal women with stage 0–III breast cancer that was estrogen-receptor-positive or progesterone-receptor-positive receiving a standard dose of a third-generation aromatase inhibitor for one month or longer and with documented AIMSS. Baseline HAQ-DI or pain using a 100-point VAS of 20 or more
• EXCLUSION CRITERIA: Acupuncture treatment within the past 12 months

• SITE: Multi-site 
• SETTING TYPE: Not specified; outpatient
• LOCATION: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; the University of Maryland Greenebaum Cancer Center

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Elder care, palliative care

• Randomized, controlled double-blind trial

• HAQ-DI
• Pain VAS

No significant difference was seen in HAQ-DI and VAS scores between the groups. A significant reduction of interleukin 17 was seen in both groups after eight weeks, and no significant changes were seen in other hormone/proinflammatory markers in either group. No significant difference were seen in AIMSS between the groups; however, after eight weeks of  treatment, HAQ-DI and VAS scores improved for both groups.

This study does not appear to support acupuncture as a means to reduce musculoskeletal symptoms in patients with breast cancer taking aromatase inhibitors. Sham and real acupuncture seem to improve HAQ-DI and VAS scores and seem to lower baseline, as revealed by a 12-week follow-up after the study. Neither acupuncture nor sham acupuncture produced any adverse effects and seem to be safe as an option for patients with early-stage breast cancer with AIMSS.

• Small sample (less than 100)
• Findings not generalizable
• The sample size limits the ability to generalize findings.
• Acupuncture training is required to perform the intervention.

This study does not support acupuncture over sham acupuncture for the treatment of AIMSS in women with early-stage breast cancer. That being said, acupuncture has helped to improve VAS and HAQ-DI scores, suggesting it as a positive intervention with no side effects for these patients. Education and training in acupuncture would be suggested prior to therapy, but this article suggests that sham acupuncture produces statistically similar results and improves scores.