Acupuncture as an Evidence-Based Option for Symptom Control in Cancer Patients

  • Stephen M. SagarEmail author
Complementary and Alternative Therapies in Oncology

Opinion statement

Current technology suggests that acupuncture modulates neurological processes within the central nervous system, especially the spinal cord gating mechanisms, cerebral subcortical nuclei, and the hypothalamic-endocrine axis. Many single arm clinical studies report the effectiveness of acupuncture for controlling symptoms in cancer patients. However, the challenge has been to separate the nonspecific effects of the practitioner, as well as regression to the mean, from the neurophysiological effects of needle penetration. Recently, randomized controlled trials have attempted to answer this question, with mixed results. For example, needle penetration (or equivalent stimulation) is effective for nausea and vomiting, whereas it does not appear to be a major factor in reducing hot flashes. Safety and quality are priorities, so regulation of the practice of acupuncture is important, as well as excellent communication between practitioners. In addition, continuing research is mandatory, using validated methodology and reporting principles as outlined in the CONSORT and STRICTA recommendations.


Radiat Oncol Biol Phys Acupuncture Treatment Dental Anxiety Sham Acupuncture Needle Penetration 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Wu MT, Hsieh JC, Xiong J, et al. Central nervous pathway for acupuncture stimulation: localization of processing with functional MR imaging of the brain—preliminary experience. Radiology. 1999, 212:133–141.PubMedGoogle Scholar
  2. 2.
    Zonenshayn M, Mogilner AY, Rezai AR. Neurostimulation and functional brain imaging. Neurol Res 2000, 22:318–325.PubMedGoogle Scholar
  3. 3.
    Campbell A. Point specificity of acupuncture in the light of recent clinical and imaging studies. Acupunct Med 2006,24:118–122Google Scholar
  4. 4.
    Listcher G. Bioengineering assessment of acupuncture, part 4: functional magnetic resonance imaging. Crit Rev Biomed Eng. 2006, 34:327–345.Google Scholar
  5. 5.
    Siedentopf CM, Golaszewski SM, Mottaghy FM, Ruff CC, Felber S, Schlager A. Functional magnetic resonance imaging detects activation of the visual association cortex during laser acupuncture of the foot in humans. Neurosci Lett. 2002, 327:53–56.CrossRefPubMedGoogle Scholar
  6. 6.••
    Lewith GT, White PJ, Pariente  J. Investigating acupuncture using brain imaging techniques: the current state of play. Evid Based Complement Alternat Med. 2005, 2:315–319.CrossRefPubMedGoogle Scholar
  7. 7.••
    Langevin HM, Yandow JA. Relationship of acupuncture points and meridians to connective tissue planes. Anat. Record (New Anat). 2002, 269:257–265.CrossRefGoogle Scholar
  8. 8.
    Shin H-S, Johng H-M, Lee B-C, et al. Feulgen reaction study of novel thread like structures (Bonghan Ducts) on the surfaces of mammalian organs. Anat Record (B New Anat) 2005, 284B:35–40.CrossRefGoogle Scholar
  9. 9.
    Langevin HM, Churchill DL, Cipolla MJ. Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. FASEB J. 2001, 15:2275–2282.CrossRefPubMedGoogle Scholar
  10. 10.
    Ahn AC, Wu J, Badger J, Hammerschlag R, Langevin HM. Electrical impedance along connective tissue planes associated with acupuncture meridians. BMC Complement Alternat Med. 2005, 5:10.CrossRefGoogle Scholar
  11. 11.
    Agelink MW, Sanner D, Eich H, Pach J, Bertling R, Lemmer W, Klieser E, Lehmann E. Does acupuncture influence the cardiac autonomic nervous system in patients with minor depression or anxiety disorders? Fortschr Neurol Psychiatr. 2003, 71:141–149Google Scholar
  12. 12.
    Mori  H, Nishijo  K, Kawamura  H, Abo T. Unique immunomodulation by electro-acupuncture in humans possibly via stimulation of the autonomic nervous system. Neurosci Lett. 2002, 320:21–24Google Scholar
  13. 13.
    Zhang X, Yuan Y, Kuang P, et al. Effects of electro-acupuncture on somatostatin and pancreatic polypeptide in ischemic cerebrovascular diseases. J Tradit Chin Med. 1999, 19:54–58.PubMedGoogle Scholar
  14. 14.
    Han JS. Acupuncture and endorphins. Neurosci Lett. 2004, 361:258–261Google Scholar
  15. 15.
    Haker E, Egekvist H, Bjerring P. Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. J Auton Nerv Sys. 2000, 79:52–59Google Scholar
  16. 16.
    White P, Lewith  G, Hopwood  V, Prescott P. The placebo needle, is it a valid and convincing placebo for use in acupuncture trials? A randomized, single-blind, cross-over pilot trial. Pain. 2003, 106:401–409Google Scholar
  17. 17.
    Moher D, Schulz KF, Altman DG. The CONSORT Statement: Revised recommendations for improving the quality of reports of parallel-group randomized trials. Annl Intern Med. 2001, 134:657–662.Google Scholar
  18. 18.••
    MacPherson H, White A, Cummings M, Jobst KA, Rose K, Niemtzow RC. Standards for reporting interventions in controlled trials of acupuncture: the STRICTA recommendations. J Alternat Complement Med. 2002, 8:85–89Google Scholar
  19. 19.
    White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med. 2004, 22:122–133Google Scholar
  20. 20.
    Taromina K, Ladas E, Rooney D, Hughes D, Meyer A, Kelly K. Acupuncture is feasible in children with cancer with low platelet counts. JSIO. 2007, 5:186.Google Scholar
  21. 21.
    Filshie J, Hester J. Guidelines for providing acupuncture treatment for cancer patients: a peer-reviewed sample policy document. Acupunct Med. 2006, 24:172–182.CrossRefPubMedGoogle Scholar
  22. 22.
    Lee A, Done ML. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis. Anesth Anal. 1999, 88:1362–1369Google Scholar
  23. 23.
    NIH Consensus Development Panel on Acupuncture. Acupuncture. JAMA. 1998, 280:1518–1524.CrossRefGoogle Scholar
  24. 24.
    Shen J, Wenger N, Glaspy J, et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis: a randomized controlled trial. JAMA. 2000, 284:2755–2761.CrossRefPubMedGoogle Scholar
  25. 25.
    Roscoe JA, Matteson SE, Morrow GR, et al. Acustimulation wrist bands are not effective for the control of chemotherapy-induced nausea in women with breast cancer. J Pain Symptom Manage. 2005, 29:376–384.CrossRefPubMedGoogle Scholar
  26. 26.••
    Ezzo J, Vickers A, Richardson MA, et al. Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting. J Clin Oncol. 2005, 23:7188–7198CrossRefPubMedGoogle Scholar
  27. 27.
    Grunberg SM, Deuson RR, Mavros P, et al. Incidence of chemotherapy-induced nausea and emesis after modern antiemetics: perception versus reality. Cancer. 2004, 100:2261–2268.CrossRefPubMedGoogle Scholar
  28. 28.
    Filshie J, Bolton T, Browne D, Ashley S. Acupuncture and self-acupuncture for long-term treatment of vasomotor symptoms in cancer patients: audit and treatment algorithm. Acupunct Med. 2005, 23:171–180.CrossRefPubMedGoogle Scholar
  29. 29.
    Tsuchiya M, Sato EF, Inoue M, Asada A. Acupuncture enhances generation of nitric oxide and increases local circulation. Anesth Analg. 2007, 104, 301–307.CrossRefPubMedGoogle Scholar
  30. 30.
    Sakai S, Hori E, Umeno K, Kitabayashi N, Ono T, Nishijo H. Specific acupuncture sensation correlates with EEGs and autonomic changes in human subjects. Auton Neurosci. 2007, 133:158–169.CrossRefPubMedGoogle Scholar
  31. 31.
    Mehling WE, Jacobs B, Acree M, et al. Symptom management with massage and acupuncture in postoperative cancer patients: a randomized controlled trial. J Pain Symptom Manage. 2007, 33:258–266.CrossRefPubMedGoogle Scholar
  32. 32.••
    Alimi D, Rubino C, Pichard-Leandri, et al. Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial. J Clin Oncol. 2003, 21:4120–4126Google Scholar
  33. 33.
    Wong R, Sagar S. Acupuncture treatment for chemotherapy-induced peripheral neuropathy: a case series. Acupunct Med. 2006; 24: 87–91.CrossRefPubMedGoogle Scholar
  34. 34.
    Lee H Schmidt K, Ernst E. Acupuncture for the relief of cancer-related pain: a systematic review. Eur J Pain. 2005, 9:437–444.CrossRefPubMedGoogle Scholar
  35. 35.
    Vickers AJ. Statistical reanalysis of four recent randomized trials of acupuncture for pain using analysis of covariance. Clin J Pain. 2004, 20:319–323CrossRefPubMedGoogle Scholar
  36. 36.
    Barlas  P, Ting SL, Chesterton LS, Jones PW Sim  J. Effects of intensity of electroacupuncture upon experimental pain in healthy human volunteers: a randomized, double-blind, placebo-controlled study. Pain. 2006, 122:81–89Google Scholar
  37. 37.
    Ghoname E-S, Craig WF, White PF, et al. Percutaneous electrical nerve stimulation for low back pain: a randomized crossover study. JAMA. 1999, 281:818–823.CrossRefPubMedGoogle Scholar
  38. 38.
    Blom M, Lundeberg T. Long-term follow-up of patients treated with acupuncture for xerostomia and the influence of additional treatment. Oral Dis. 2000, 6:15–24.PubMedGoogle Scholar
  39. 39.
    Johnstone PA, Peng YP, May BC, et al. Acupuncture for pilocarpine-resistant xerostomia following radiotherapy for head and neck malignancies. Int J Radiat Oncol Biol Phys. 2001, 50:353–357.CrossRefPubMedGoogle Scholar
  40. 40.••
    Wong RKW, Jones GW, Sagar SM, Fargas-Babjak A, Whelan T. A phase I/II study in the use of acupuncture-like transcutaneous nerve stimulation in the treatment of radiation-induced xerostomia in head and neck cancer patients treated with radical radiotherapy. Int J Radiat Oncol Biol Phys. 2003;57:472–480.CrossRefPubMedGoogle Scholar
  41. 41.••
    Karst M, Winterhalter M, Munte S, et al. Auricular acupuncture for dental anxiety: a randomized controlled trial. Anesth Analg 2007; 104: 295–300.CrossRefPubMedGoogle Scholar
  42. 42.
    Wang SM, Punjala M, Weiss D, Anderson K, Kain ZN. Acupuncture as an adjunct for sedation during lithotripsy. J Altern Complement Med. 2007, 13:241–246.CrossRefPubMedGoogle Scholar
  43. 43.
    Kober A, Scheck T, Schubert B, et al Auricular acupressure as a treatment for anxiety in prehospital transport settings. Anesthesiology 2003;98:1328–1332.CrossRefPubMedGoogle Scholar
  44. 44.
    Wang SM, Maranets I, Weinberg ME, Caldwell-Andrews AA, Kain ZN. Parental auricular acupuncture as an adjunct for parental presence during induction of anesthesia. Anesthesiology. 2004, 100:1399–1404.CrossRefPubMedGoogle Scholar
  45. 45.
    Fanti L, Gemma M, Passaretti S. Electroacupuncture analgesia for colonoscopy: a prospective, randomized, placebo-controlled study. Am J Gastroenterol. 2003;98:312–316.PubMedGoogle Scholar
  46. 46.
    Roschke J, Wolf C, Muller MJ et al. The benefit from whole body acupuncture in major depression. J Affect Disord. 2000, 57:73–81.CrossRefPubMedGoogle Scholar
  47. 47.••
    Leo RJ, Ligot JS. A systematic review of randomized controlled trials of acupuncture in the treatment of depression. J Affect Disord. 2007, 97:13–22.CrossRefPubMedGoogle Scholar
  48. 48.
    Smith CA, Hay PP. Acupuncture for depression. Cochrane Database Syst Rev. 2005, 2:CD004046 (ISSN: 1469-493X)Google Scholar
  49. 49.
    Yu J, Liu C, Zhang X, Han J. Acupuncture improved cognitive impairment caused by multi-infaRCT dementia in rats. Physiol Behav. 2005, 86: 434–441.CrossRefPubMedGoogle Scholar
  50. 50.
    Johnston MF, Yang C, Hui K-K, Xiao B, Li X, Rusiewicz A. Acupuncture for chemotherapy-associated cognitive dysfunction: a hypothesis-generating literature review to inform clinical advice. Integr Cancer Ther 2007, 6:36–40.CrossRefPubMedGoogle Scholar
  51. 51.
    Bonta IL. Acupuncture beyond the endorphin concept? Med Hypotheses. 2002, 58:221–224.CrossRefPubMedGoogle Scholar
  52. 52.••
    Vickers AJ, Straus DJ, Fearon B, Cassileth BR. Acupuncture for postchemotherapy fatigue: a phase II study. J Clin Oncol. 2004, 22:1731–1735.CrossRefPubMedGoogle Scholar
  53. 53.
    Smith P, Moscrop D, Davies S, Sloan P, Al-Ani Z. The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: a randomised controlled trial. J Dent. 2007; 35: 259–267.CrossRefPubMedGoogle Scholar
  54. 54.
    Vickers AJ, Feinstein MB, Deng GE, Cassileth BR. Acupuncture for dyspnea in advanced cancer: a randomized, placebo-controlled pilot trial. BMC Palliat Care. 2005, 4:5.CrossRefPubMedGoogle Scholar
  55. 55.
    Tukmachi E. Treatment of hot flushes in breast cancer patients with acupuncture. Acupunct in Med. 2000; 18:22–27.CrossRefGoogle Scholar
  56. 56.
    Vincent A, Barton DL, Mandrekar JN, Cha SS, et al. Acupuncture for hot flashes: A randomized, sham-controlled clinical study. Menopause. 2007, 14:45–52.CrossRefPubMedGoogle Scholar
  57. 57.••
    Deng G, Vickers A, Yeun S, Cassileth B. Randomized, Controlled Trial of Acupuncture for the Treatment of Hot Flashes in Breast Cancer Patients. J Clin Oncol 2007; 25:5584–5590.CrossRefPubMedGoogle Scholar
  58. 58.
    Arranz L, Guayerbas N, Siboni L, De la Fuente M. Effect of acupuncture treatment on the immune function impairment found in anxious women. Am J Chin Med 2007, 35:35–51.CrossRefPubMedGoogle Scholar
  59. 59.
    Lu W, Hu D, Dean-Clower E, et al. Acupuncture for chemotherapy-induced leukopenia: exploratory meta-analysis of randomized controlled trials. J Soc Integrat Oncol. 2007; 5: 1–10.CrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Departments of Oncology and MedicineMcMaster UniversityHamiltonCanada

Personalised recommendations