A randomised trial of electro-acupuncture for arthralgia related to aromatase inhibitor use

• Type of Material: Article
• Authors: Jun J. Mao, University of Pennsylvania; Sharon X. Xie, University of Pennsylvania; John T. Farrar, University of Pennsylvania; Carrie T. Stricker, University of Pennsylvania; Marjorie A. Bowman, Wright State University; Deborah Bruner, Emory University; Angela DeMichele, University of Pennsylvania
• Language: English
• Date: 2014-01-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 Elsevier Ltd. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ejca.2013.09.022
• Title of Journal or Parent Work: EJC Supplements
• ISSN: 1359-6349
• Volume: 50
• Issue: 2
• Start Page: 267
• End Page: 276
• Grant/Funding Information: This study is supported by grants from the National Institutes of Health / National Center for Complementary and Alternative Medicine (NCCAM) R21 AT004695.; Dr. Mao is a recipient of the NCCAM K23 AT004112 award.
• Keywords: Clinical trial; Adverse effects; Aromatase inhibitors; MANAGEMENT; Breast neoplasm; DISCONTINUATION; ACUPUNCTURE; Acupuncture; Joint pain; Oncology; SYMPTOMS; Life Sciences & Biomedicine; Musculoskeletal; Science & Technology
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

Background: Arthralgia is a common and debilitating side-effect experienced by breast cancer patients receiving aromatase inhibitors (AIs) and often results in premature drug discontinuation. Methods: We conducted a randomised controlled trial of electro-acupuncture (EA) as compared to waitlist control (WLC) and sham acupuncture (SA) in postmenopausal women with breast cancer who self-reported arthralgia attributable to AIs. Acupuncturists performed 10 EA/SA treatments over 8 weeks using a manualised protocol with 2 Hz electro-stimulation delivered by a TENS unit. Acupuncturists administered SA using Streitberger (non-penetrating) needles at non-traditional acupuncture points without electro-stimulation. The primary end-point was pain severity by Brief Pain Inventory (BPI) between EA and WLC at Week 8; durability of response at Week 12 and comparison of EA to SA were secondary aims. Findings: Of the 67 randomly assigned patients, mean reduction in pain severity was greater in the EA group than in the WLC group at Week 8 (-2.2 versus -0.2, p = 0.0004) and at Week 12 (-2.4 versus -0.2, p < 0.0001). Pain-related interference measured by BPI also improved in the EA group compared to the WLC group at both Week 8 (-2.0 versus 0.2, p = 0.0006) and Week 12 (-2.1 versus -0.1, p = 0.0034). SA produced a magnitude of change in pain severity and pain-related interference at Week 8 (-2.3, -1.5 respectively) and Week 12 (-1.7, -1.3 respectively) similar to that of EA. Participants in both EA and SA groups reported few minor adverse events. Interpretations: Compared to usual care, EA produced clinically important and durable improvement in arthralgia related to AIs in breast cancer patients, and SA had a similar effect. Both EA and SA were safe.