Garcia, M.K., Driver, L., Haddad, R., Lee, R., Palmer, J.L., Wei, Q., . . . Cohen, L. (2014). Acupuncture for treatment of uncontrolled pain in cancer patients: A pragmatic pilot study. Integrative Cancer Therapies, 13, 133–140.

To test the hypotheses that acupuncture would be feasible, safe, and effective adjunct for pain management

Patients were recruited from referrals to a pain management center. Patients received individualized acupuncture treatments one to three times per week. Treatments were provided by two licensed and experienced acupuncturists. The points used in the treatments are described, and standard techniques for point location were used. Needles were left in place for about 25 minutes. Electrical stimulation was added at the discretion of the practitioner. Study measures were obtained at baseline and after the last acupuncture session. Patients were dropped from the analysis if pain control medications were changed during the course of the study.

• N = 41  
• MEAN AGE = 54 years (range = 33–88 years)
• MALES: 29%, FEMALES: 71%
• KEY DISEASE CHARACTERISTICS: Multiple tumor types (breast was most common); patients had varied stages of disease
• OTHER KEY SAMPLE CHARACTERISTICS: Pain scores were > 4 on a numeric rating scale at study entry, and mean duration of pain management we 31 months. There were varied locations of pain with low back, neck, and shoulder being the most common. Most patients had multiple locations of pain.

• SITE: Single-site    
• SETTING TYPE: Outpatient    
• LOCATION: Texas

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

Single-arm prospective trial

• Brief Pain Inventory (BPI)
• MD Anderson Symptom Inventory (MASI)

The average number of treatments was eight (range = 2–10) over five weeks excluding drop-outs. 71% of patients received auricular acupuncture and 71% received electroacupuncture. Pain severity and interference scores declined significantly (p < .0011) using the BPI. A significant reduction in both of these aspects was also seen with the MASI (p < .002). Intent-to-treat analysis using the replacement of missing values with group means showed the same results. For 44% of patients, pain medications remained the same as those at baseline. Fewer patients required opioids at follow-up compared to baseline, and the prevalence of use of other medications for pain such as nonopioid analgesics, antidepressants, and other adjuvant medications declined. 87% of patients stated that the course of acupuncture treatment met their expectations very or extremely well. There were no adverse effects of acupuncture reported.

Findings suggest that the use of acupuncture as an adjunctive therapy for chronic pain management is feasible, is safe, and can be beneficial in reducing pain.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Unintended interventions or applicable interventions not described that would influence results
• Subject withdrawals ≥ 10%  
• Other limitations/explanation: Although it was stated that patients were not to have pain medication changed during the study, substantial changes in various medications occurred and were reported. There was a 21% drop-out rate with about 40% of these due to changes in pain medication.

Findings suggest that acupuncture treatment as an adjunctive pain management approach can be beneficial for some patients. Interpretation of findings is difficult due to the individualization of the treatment regimen, study design limitations, and the likelihood that there is a placebo effect with acupuncture. For those patients who wish to try acupuncture for pain management, it appears to be feasible and safe when provided by appropriate practitioners.