Question
What is the efficacy of acupuncture for relieving cancer-related pain in adults?
Relevance to nursing care
Nurses are often approached by patients regarding the use and/or the recommendation of the use of acupuncture for cancer-related pain. Acupuncture is widely accepted and practised for various medical conditions such as osteoarthritis, chronic lower back pain and post-operative pain. It is essential for nurses to be updated on the efficacy of acupuncture for managing cancer-related pain so they can educate their patients in accordance with the best available evidence.
Study characteristics
Three trials with a total of 204 participants were included in the review.1 The inclusion criteria were adult participants aged 18 years and above who had cancer-related pain and were receiving any type of invasive Western or traditional Chinese style acupuncture. The primary outcome measure was participant-reported pain intensity using validated scales or verbal reporting. Methodological qualities of the trials were assessed using a modified version of the 5-point Oxford Quality Scale. Only one trial was identified as being of high quality as it adequately described randomisation, assessor blinding and dropouts adequately. The other two trials lacked reporting of whether the assessor and/or subject were blinded and there was no reporting on withdrawal rates. Pooling of the results was not possible due to heterogeneity in different types of acupuncture used and measurement in pain reporting. The major review findings were reported in narrative text as follows:
* Pain intensity on a visual analogue scale significantly decreased in acupuncture group compared with placebo at both day 30 and 60.
* Acupuncture was more effective when compared with medication.
* The Western medication group experienced more effective immediate pain relief during the first 10 days than the filiform needle or point injection group. However, the effects were similar between those receiving Western medication and those receiving acupuncture by the final 10 days.
Implications for nursing care
Whilst acupuncture gives relief from pain, the use of pain medication gives more immediate relief. Therefore, acupuncture is not recommended as a stand-alone therapy for pain relief for adult patients who have cancer-related pain. Nurses are encouraged to recommend evidence-proven strategies for patients to manage their cancer-related pain.
Implications for research
Future research on the use of acupuncture in this area needs to strengthen the power and sample size calculation, as well as ensure the homogeneity of the cancer pain condition, assessor blinding, the use of an optimal dose of acupuncture and appropriate use of a control group before acupuncture would be considered as a 'recommended practice'.
1National University Cancer Institute, Singapore; National University Health System, A member of the Cochrane Nursing Care Field (CNCF)
Reference