Skip to main content
SpringerLink
Log in

Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Controlling cancer-related pain is an important component in the palliative care of cancer patients. The objective of this review was to assess the effectiveness of acupuncture for treating cancer pain.

Methods

Fourteen databases were searched from their inception through April 2011. Randomised clinical trials (RCTs) were included if acupuncture was used as the sole treatment or as a part of a combination therapy for cancer pain. Studies were included if they were controlled with a placebo or controlled against a drug-therapy or no-treatment group. The Cochrane criteria were used to assess the risk of bias.

Results

A total of 15 RCTs met our inclusion criteria. All of the included RCTs were associated with a high risk of bias. The majority of acupuncture treatments or combination therapies with analgesics exhibited favourable effects compared with conventional treatments in individual studies. However, a meta-analysis suggested that acupuncture did not generate a better effect than drug therapy (n = 886; risk ratio (RR), 1.12; 95% CI 0.98 to 1.28; P = 0.09). The comparison between acupuncture plus drug therapy and drug therapy alone demonstrated a significant difference in favour of the combination therapy (n = 437; RR, 1.36; 95% CI 1.13 to 1.64; P = 0.003). The results of this systematic review provide no strong evidence for the effectiveness of acupuncture in the management of cancer pain.

Conclusion

The total number of RCTs included in the analysis and their methodological quality were too low to draw firm conclusions. Future rigorous RCTs will be necessary to assess the clinical efficacy of acupuncture in this area.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. American Pain Society (2008) Principles of analgesic use in the treatment of acute pain and cancer pain. 6th ed. Glenview, IL: American Pain Society

  2. National Comprehensive Cancer Network (2010) Clinical practice guidelines in oncology for adult cancer pain. Fort Washington, PA: National Comprehensive Cancer Network: Available at: www.nccn.org. Accessed November 1, 2010

  3. Burton AW, Fanciullo GJ, Beasley RD, Fisch MJ (2007) Chronic pain in the cancer survivor: a new frontier. Pain Med 8:189–198

    Article  PubMed  Google Scholar 

  4. Breivik H, Cherny N, Collett B, Fd C, Filbet M, Foubert AJ, Cohen R, Dow L (2009) Cancer-related pain: a Pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20:1420–1433

    Article  PubMed  CAS  Google Scholar 

  5. Hsieh RK (2005) Pain control in Taiwanese patients with cancer: a multicenter, patient-oriented survey. J Formos Med Assoc 104:913–919

    PubMed  Google Scholar 

  6. Korean Society for Hospice and Palliative Care (2001) Cancer pain relief guideline. Seoul: Korean Society for Hospice and Palliative Care, Korean Cancer Study Group

  7. Soyannwo O (2009) Cancer pain–progress and ongoing issues in Africa. Pain Res Manag 14:349

    PubMed  Google Scholar 

  8. Koshy RC, Rhodes D, Devi S, Grossman SA (1998) Cancer pain management in developing countries: a mosaic of complex issues resulting in inadequate analgesia. Support Care Cancer 6:430–437

    Article  PubMed  CAS  Google Scholar 

  9. Quugley C (2008) Opioids in people with cancer-related pain. Clin Evid: 2408

  10. Chen CH, Tang ST, Chen CH (2011) Meta-analysis of cultural differences in Western and Asian patient-perceived barriers to managing cancer pain. Palliat Med [Epub ahead of print]

  11. Stjernsward J, Colleau SM, Ventafridda V (1996) The World Health Organization Cancer Pain and Palliative Care Program. Past, present, and future. J Pain Symptom Manage 12:65–72

    Article  PubMed  CAS  Google Scholar 

  12. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van KM, Patijn J (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18: 1437–1449

    Google Scholar 

  13. Harris J-D (2008) Management of expected and unexpected opioid-related side effects. Clin J Pain 24:S8–S13

    Article  PubMed  Google Scholar 

  14. Schug SA, Zech D, Grond S (1992) Adverse effects of systemic opioid analgesics. Drug saf 7:200–213

    Article  PubMed  CAS  Google Scholar 

  15. Cassileth B, Trevisan C, Gubili J (2007) Complementary therapies for cancer pain. Curr Pain Headache Rep 11:265–269

    Article  PubMed  Google Scholar 

  16. Cleary J (2007) The pharmacologic management of cancer pain. J Palliat Med 10:1369–1394

    Article  PubMed  Google Scholar 

  17. American College of Chest Physicians (2007) New ACCP cancer care guidelines include CAM. J Altern Complement Med 13:1049

    Article  Google Scholar 

  18. Richardson MA, Sanders T, Palmer JL, Greisinger A, Singletary SE (2000) Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol 18:2505–2514

    PubMed  CAS  Google Scholar 

  19. Goudas LC, Bloch R, Gialeli-Goudas M, Lau J, Carr DB (2005) The epidemiology of cancer pain. Cancer Invest 23:182–190

    Article  PubMed  Google Scholar 

  20. Ernst E, Lee MS (2010) Acupuncture for palliative and supportive cancer care: a systematic review of systematic reviews. J Pain Symptom Manage 40:e3–e5

    Google Scholar 

  21. Filshie J, Thompson JW (2009) The Oxford textbook of palliative medicine. Oxford University Press

  22. Lee H, Schmidt K, Ernst E (2005) Acupuncture for the relief of cancer-related pain: a systematic review. Eur J Pain 9:437–444

    Article  PubMed  Google Scholar 

  23. Peng H, Peng HD, Xu L, Lao LX (2010) Efficacy of acupuncture in treatment of cancer pain: a systematic review. J Chin Integr Med 8:501–509

    Article  Google Scholar 

  24. Higgins JPT, Green S, eds. (2008) Chapter 8: Assessing risk of bias in included studies. In: Higgins J, Altman DG (eds) Cochrane handbook for systematic reviews of intervention. Wiley-Blackwell, West Sussex, England, pp. 187–241.

  25. Hu X, Gu W, Zhou QH (2005) Analgesic efficacy and mechanism of wrist-ankle acupuncture on pain caused by liver cancer. Chin J Integr Med 15:131–133

    Google Scholar 

  26. Hu X, Ling CQ, Zhou QH (2004) Clinical observation on wrist–ankle acupuncture for treatment of pain of middle-late liver cancer. Chin Acupunct Moxibustion 24:149–151

    CAS  Google Scholar 

  27. Sun YL, Yu LR (2000) Observation on therapeutic effect of needle-retaining method of triple acupuncture in 80 cases of pain due to liver cancer. Chin Acupunct Moxibustion 21:211–212

    Google Scholar 

  28. Mi JP, Deng TW, Zhou DJ (2010) Clinical observation on fire acupuncture and three step analgesic ladder treatment for stomach cancer. Liaoning J Tradit Chin Med 37:2018–2019

    Google Scholar 

  29. Dang W, Yang JB (1998) Clinical study on acupuncture treatment of stomach carcinoma pain. J Tradit Chin Med 18:31–38

    PubMed  CAS  Google Scholar 

  30. Chen ZJ, Guo YP, Wu ZC (2008) Observation on the therapeutic effect of acupuncture at pain points on cancer pain. Chin Acupunct Moxibustion 28:251–253

    CAS  Google Scholar 

  31. Qiao DP, Liu L, Liang YT (2008) Efficacy of acupuncture combined with drug treatment for cancer pain. J Pract Oncol 22:449–449

    Google Scholar 

  32. Peng H (2009) Systematic evaluation of the effect of acupuncture therapy on cancer pain and pilot clinical trial. Second Military Medical University: Masters degree, Shanghai, P.R. China

  33. Alimi D, Rubino C, Pichard-Leandri E, Fermand-Brule S, Dubreuil-Lemaire ML, Hill C (2003) Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial. J Clin Oncol 21:4120–4126

    Article  PubMed  Google Scholar 

  34. Zhang M, Xia T, Wu SH, Zhang ZH, Zhang YJ (2000) Analgesic effect of Chinese herbs and acupuncture on cancer patients. Acupunct research 25:64–66

    CAS  Google Scholar 

  35. Bian RH (1999) Observation on analgesic effect of acupuncture on carcinous pain. J Pract Traditi Chin Med 15:28

    Google Scholar 

  36. Dan Y, Yang YB, Tao Y (1998) Clinical research on analgesic effect of acupuncture for pain in cancer. Chin Acupunct Moxibustion 19:17–18

    Google Scholar 

  37. Chen H, Liu Y (2002) Effective observations on treating cancerous pain by acupuncture and moxibustion and three levels analgesia. Chin J Pract Chin Mod Med 2:1125–1126

    Google Scholar 

  38. Shen SE (2000) Clinical investigation on analgesic effect of wrist-ankle needling in the patient of cancer. Chin Acupunct Moxibustion 21:143–144

    Google Scholar 

  39. Xia YQ, Zhang D, Yang CX, Xu HL, Li Y, Ma LT (1986) An approach to the effect on tumors of acupuncture in combination with radiotherapy or chemotherapy. J Tradit Chin Med 6:22–26

    Google Scholar 

  40. Kaptchuk TJ (2002) Acupuncture: theory, efficacy and practice. Ann Intern Med 136:374–383

    PubMed  Google Scholar 

  41. Pittler MH, Abbot NC, Harkness EF, Ernst E (2000) Location bias in controlled clinical trials of complementary/alternative therapies. J Clin Epidemiol 53:485–489

    Article  PubMed  CAS  Google Scholar 

  42. Ernst E, Pittler MH (1997) Alternative therapy bias. Nature 385:480

    Article  PubMed  CAS  Google Scholar 

  43. Northeim AJ (1996) Adverse effects of acupuncture: a study of the literature for the years 1981–1994. J Altern Complement Med 2:291–297

    Article  Google Scholar 

  44. Caraceni A, Brunelli C, Martini C, Zecca E, De Conno F (2005) Cancer pain assessment in clinical trials. A review of the literature (1999–2002). J Pain Symptom Manage 29:507–519

    Article  PubMed  Google Scholar 

  45. Carr DB, Goudas LC, Balk EM, Bloch R, Ioannidis JP, Lau J (2004) Evidence report on the treatment of pain in cancer patients. J Natl Cancer Inst Monogr 32:23–31

    Google Scholar 

  46. Kaasa S (2008) Palliative care research: time to intensify international collaboration. Palliat Med 22:301–302

    Article  PubMed  CAS  Google Scholar 

  47. Mao-Ying QL, Cui KM, Liu Q, Dong ZQ, Wang W, Wang J, Sha H, Wu GC, Wang YQ (2006) Stage-dependent analgesia of electro-acupuncture in a mouse model of cutaneous cancer pain. Eur J Pain 10:689–694

    Article  PubMed  Google Scholar 

  48. Wang JY, Xu L, Zhang RX, Lao L (2011) Traditional Chinese medicine for cancer pain. J Chin Integr Med 9:129–134

    Article  Google Scholar 

  49. Paley CA, Johnson MI, Tashani OA, Bagnall AM (2011) Acupuncture for cancer pain in adults. Cochrane Database Syst Rev 19:CD007753

    Google Scholar 

  50. Zhang RX, Li A, Liu B, Wang L, Ren K, Qiao JT, Berman BM, Lao L (2007) Electroacupuncture attenuates bone cancer pain and inhibits spinal interleukin-1 beta expression in a rat model. Anesth Analg 105:1482–1488, Table of contents

    Article  PubMed  CAS  Google Scholar 

  51. Sabino MA, Mantyh PW (2005) Pathophysiology of bone cancer pain. J Support Oncol 3:15–24

    PubMed  CAS  Google Scholar 

  52. Zhang RX, Li A, Liu B, Wang L, Xin J, Ren K, Qiao JT, Berman BM, Lao L (2008) Electroacupuncture attenuates bone-cancer-induced hyperalgesia and inhibits spinal preprodynorphin expression in a rat model. Eur J Pain 12:870–878

    Article  PubMed  CAS  Google Scholar 

  53. Lee HJ, Lee JH, Lee EO, Lee HJ, Kim KH, Lee KS, Lee CH, Nam DW, Kim SH, Lee HJ, Ahn KS (2009) Substance P and beta endorphin mediate electroacupuncture induced analgesic activity in mouse cancer pain model. Acupunct Electrother Res 34:27–40

    PubMed  Google Scholar 

  54. White A (2009) Western medical acupuncture: a definition. Acupunct Med 27:33–35

    Article  PubMed  Google Scholar 

  55. White A, Cummings M, Filshie J (2008) An introduction to western medical acupuncture. Elsevier, UK

    Google Scholar 

Download references

Acknowledgments

Tae-Young Choi and Myeong Soo Lee were supported by Korea Institute of Oriental Medicine (K11111 and K11130).

Conflict of interest

None declare.

Author information

Authors and Affiliations

  1. Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, South Korea

    Tae-Young Choi, Myeong Soo Lee & Tae-Hun Kim

  2. Complementary Medicine, Peninsula Medical School, University of Exeter, Exeter, UK

    Edzard Ernst

  3. College of Traditional Chinese Medicine, University of Technology, Sydney, Australia

    Christopher Zaslawski

Authors
  1. Tae-Young Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Myeong Soo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tae-Hun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher Zaslawski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Edzard Ernst
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Myeong Soo Lee.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 24 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Choi, TY., Lee, M.S., Kim, TH. et al. Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials. Support Care Cancer 20, 1147–1158 (2012). https://doi.org/10.1007/s00520-012-1432-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-012-1432-9

Keywords

Search

Navigation