Chen, H., Liu, T.Y., Kuai, L., Zhu, J., Wu, C.J., & Liu, L.M. (2013). Electroacupuncture treatment for pancreatic cancer pain: A randomized controlled trial. Pancreatology, 13, 594–597. 

To evaluate the analgesic effect of electroacupuncture on pancreatic cancer pain

Patients were treated in a comfortable prone position. Disposable stainless steel filiform needles (40 mm in length and 0.3 mm in diameter) were inserted perpendicularly into the Jiaji points from T8 to T12 bilaterally to a depth of 25 mm. After de-qi sensation was achieved, the handles of the needles were respectively connected to a Han's acupoint nerve stimulator (HANS) at a frequency of 2/100 Hz and a current of 1 mA with a disperse-dense waveform. The needles remained in place for 30 minutes. The treatment was given once a day for three days. Sham acupuncture needles were used as a placebo and were put into the same points in the treatment group without inserting into the skin. The needles were then connected to the electric stimulator but with zero frequency and electric current. All patients were to maintain the same analgesic drug treatment.

• N = 60  
• AGE RANGE = 18–75 years
• MALES: 63.3% treatment arm (66.7% control arm), FEMALES: 36.7% treatment arm (33.3% control arm)
• KEY DISEASE CHARACTERISTICS: Histologically confirmed advanced pancreatic cancer at stages III–IV in the staging system of the Union for International Cancer Control
• OTHER KEY SAMPLE CHARACTERISTICS: Pain intensity of 3–6 on numeric rating scale (0–10), stable dose of analgesics at least 72 hours before randomization, estimated survival time greater than one month, never been treated by acupuncture, no other causes of pain (e.g., rheumatoid arthritis, disc disease), no contraindications for acupuncture (e.g., bleeding risk, infectious dermatosis, ulcer or scar at acupuncture points) or history of cerebrovascular accident (CVA) or spinal cord injury, study completed before treatment for pancreatic cancer

• SITE: Single-site    
• SETTING TYPE: Not specified    
• LOCATION: Fudan University Shanghai Cancer Center (FUSCC)

• PHASE OF CARE: Mutliple phases of care
• APPLICATIONS: Palliative care 

Pain intensity as assessed using a numeric rating scale of 0–10 after subjects were given an explanation of the rating scale. Ratings were done before treatment, after one to three treatments, and at one and two days after the completion of the treatments.

• Numeric rating scale from 0–10
• Analgesic record
• Adverse events

Pain intensity decreased compared with baseline after each of the three treatments in the acupuncture group. There was little change in the level of pain in the control group. The difference between the treatment arm and the control arm was statistically significant after each of the three treatments. Follow-up during the two days after treatment also showed a significant reduction in pain intensity in the treatment arm compared to the control arm. No infections at the treated points were noted during the trial, and there were no adverse events.

Pain intensity significantly decreased compared to baseline in the electroacupuncture group, a result that was significantly different than the result for those in the control arm of the study. There was no significant difference in the level of pain at any of the time points for those in the control arm of the study.

• Small sample (< 100)
• Risk of bias (no blinding)
• Findings not generalizable
• Other limitations/explanation: The study only included mild to moderate levels of pain. Pain was only assessed for two days after the treatment.

Pain is a significant problem for individuals diagnosed with pancreatic cancer. Standard treatment options include opioids, radiotherapy, and celiac plexus neurolysis; however, these are not always effective and may be limited due to their side effects. Nurses need to be aware of potential pain management options for patients with pancreatic cancer-associated pain in order to improve the patients' quality of life.