Shay B1, Hammond E2, Pitz M3,4
1University of Manitoba, Physical Therapy, Winnipeg, Canada, 2University of Manitoba, Human Anatomy and Cell Science, Winnipeg, Canada, 3University of Manitoba, Internal Medicine, Winnipeg, Canada, 4Research Institute in Oncology and Hematology, Winnipeg, Canada
Background: Chemotherapy Induced Peripheral Neuropathy (CIPN) is a leading complaint among cancer survivors and can result in lasting symptoms of neuropathic pain or hypoesthesia (Sisignano, Baron, Scholich, & Geisslinger, 2014). Despite the prevalence and persistence of symptoms, there are currently few treatments available (Hershman et al., 2014). The 1997 NIH consensus statement and a prospective randomized controlled trial for electro acupuncture (EA) and chemotherapy-induced emesis have led to increasing acceptance for acupuncture among cancer patients and the medical community (Acupuncture, 1997; Cohen, Menter, & Hale, 2005; Shen et al., 2000). The efficacy for acupuncture specific to the treatment of cancer pain is limited. Further, the current research for acupuncture and CIPN treatment lack important scientific standards including homogenous populations, sham groups, valid and reliable outcome measures, reported acupuncture points, treatment time and duration (Y. Bao et al., 2014; Choi, Lee, Kim, Zaslawski, & Ernst, 2012; Cohen et al., 2005; H. Lee, Schmidt, & Ernst, 2005; Paley, Tashani, Bagnall, & Johnson, 2011).
Purpose: This prospective double-blind randomized controlled trial (RCT) sought to answer whether electro acupuncture (EA) could improve chronic neuropathic CIPN pain in breast cancer patients exposed to taxane chemotherapy compared to a sham control group.
Methods: 18 participants (10 treatment and 8 sham) were recruited from the cancer registry at CancerCare Manitoba. The primary outcome measure was the numeric pain rating scale (NPRS). Subjective questionnaires and Quantitative Sensory Testing (QST) were used to establish nerve pain and function for baseline and the follow up post 6-week trial. Acupuncture treatment consisted of points ST36, LR3, and LI4 bilaterally x 30 minutes, once a week over 6 weeks. EA was applied to ST36 at 2Hz at maximum tolerance. Sham acupuncture using Streitberger Placebo Needles (Asiamed) included the same points and treatment parameters.
Results: Baseline NPRS scores were equal between the groups with sham median (Q1-Q3) 5.5 (4.75-6.0) and true 5.0 (3.5-7.75) NS. Post pain scores revealed a statistically significant and clinically relevant improvement for the sham group with a reduction in pain to 2.50 (2.0-3.0), p=0.04 compared to the true acupuncture group 4.25 (3.25-5.0) that demonstrated no clinical improvement. No other statistically significant differences were observed.
Conclusion(s): This trial used best practice, incorporated a homogeneous population, used valid and reliable outcome measures, and sham controls. This current study clearly demonstrates that EA treatment is not recommended for this population. Future studies to evaluate acupuncture independent of EA need to be completed.
Implications: Could it be possible that EA maintains neuropathic pain? We wonder if EA (meant to strengthen the clinical response) provided too much stimulation to the already upregulated nervous system in neuropathic pain. Electrical stimulation may be a driver maintaining neuropathic pain via upregulation of glia/astrocyte signaling. Constant peripheral input is known to maintain spinal cord dorsal horn excitability, cortical changes, central sensitization and impaired descending noxious inhibitory control (DNIC).
Keywords: electro acupuncture (EA), neuropathic pain, chemotherapy induced peripheral neuropathy (CIPN)
Funding acknowledgements: Acupuncture Division - Physiotherapy Foundation of Canada
University of Manitoba- College of Rehabilitation Sciences (CoRS) - Catalyst Grant
Purpose: This prospective double-blind randomized controlled trial (RCT) sought to answer whether electro acupuncture (EA) could improve chronic neuropathic CIPN pain in breast cancer patients exposed to taxane chemotherapy compared to a sham control group.
Methods: 18 participants (10 treatment and 8 sham) were recruited from the cancer registry at CancerCare Manitoba. The primary outcome measure was the numeric pain rating scale (NPRS). Subjective questionnaires and Quantitative Sensory Testing (QST) were used to establish nerve pain and function for baseline and the follow up post 6-week trial. Acupuncture treatment consisted of points ST36, LR3, and LI4 bilaterally x 30 minutes, once a week over 6 weeks. EA was applied to ST36 at 2Hz at maximum tolerance. Sham acupuncture using Streitberger Placebo Needles (Asiamed) included the same points and treatment parameters.
Results: Baseline NPRS scores were equal between the groups with sham median (Q1-Q3) 5.5 (4.75-6.0) and true 5.0 (3.5-7.75) NS. Post pain scores revealed a statistically significant and clinically relevant improvement for the sham group with a reduction in pain to 2.50 (2.0-3.0), p=0.04 compared to the true acupuncture group 4.25 (3.25-5.0) that demonstrated no clinical improvement. No other statistically significant differences were observed.
Conclusion(s): This trial used best practice, incorporated a homogeneous population, used valid and reliable outcome measures, and sham controls. This current study clearly demonstrates that EA treatment is not recommended for this population. Future studies to evaluate acupuncture independent of EA need to be completed.
Implications: Could it be possible that EA maintains neuropathic pain? We wonder if EA (meant to strengthen the clinical response) provided too much stimulation to the already upregulated nervous system in neuropathic pain. Electrical stimulation may be a driver maintaining neuropathic pain via upregulation of glia/astrocyte signaling. Constant peripheral input is known to maintain spinal cord dorsal horn excitability, cortical changes, central sensitization and impaired descending noxious inhibitory control (DNIC).
Keywords: electro acupuncture (EA), neuropathic pain, chemotherapy induced peripheral neuropathy (CIPN)
Funding acknowledgements: Acupuncture Division - Physiotherapy Foundation of Canada
University of Manitoba- College of Rehabilitation Sciences (CoRS) - Catalyst Grant
Topic: Pain & pain management; Oncology, HIV & palliative care
Ethics approval required: Yes
Institution: University of Manitoba
Ethics committee: Health Research Ethics Board (HREB)
Ethics number: H:2015:282
All authors, affiliations and abstracts have been published as submitted.
