Research on Acupuncture for Joint Pain in Breast Cancer

Some of you may know that for the past several years Adam has been performing the acupuncture for two acupuncture clinical trials for breast cancer patients at the University of Pennsylvania. Both of the studies are now complete and one of them was recently published. You can read a write-up about the published study on the Huffington Post website.

This study investigated the use of acupuncture to help control the joint pain that is a common side effect of a class of medications called aromatase-inhibitors (or AIs). Postmenopausal breast cancer patients with hormone-sensitive cancers are often put on AIs in order to help keep estrogen levels low and prevent an exacerbation or recurrence of the cancer. Patients are typically on AIs for 5 years. Unfortunately, joint pain is a serious and common side effect of AIs, so much so that many patients stop taking the medications before the recommended 5 year period is complete. The results of the study were positive and significant, showing that acupuncture was able to lower pain scores.

The patients in our study were randomized to one of three treatment groups: real acupuncture, sham acupuncture or waitlist control. Most of you are probably wondering what sham acupuncture is and why we would use it, so I’ll fill you in. The sham acupuncture is theoretically used as a placebo control. To perform sham acupuncture, we use a blunt-tipped needle for which the body of the needle retracts into the handle of the needle (like a stage dagger) when it is pressed into the skin. We also apply the sham needles at “sham” acupuncture points that do not lie on the regular meridians.

The use of sham acupuncture in research is a very controversial topic, with many people feeling that, for several reasons, it is not an inert intervention and therefore not a reliable placebo. Two of the main reasons that some people feel sham acupuncture is unreliable have to do with the type of needle used and the points selected. There are, in fact, styles of acupuncture treatment that are “non-insertive”. To perform a non-insertive acupuncture treatment, practitioners hold the needles on top of the patient’s skin at the acupuncture point and the needle never penetrates through the skin (much like the sham needles). Toyohari is one of these non-insertive styles of acupuncture. We were exposed to Toyohari during our education at NESA, where several professors use the style in their practices.

The other issue is the use of sham acupuncture points. There are many in the field that state that there is no such thing as a sham point and that all points on the body can and do have some effect on the patient. The “real” points we used in our study, and the points that are used in most acupuncture research, are based on TCM (Traditional Chinese Medicine) theory. Once again, there are other styles of acupuncture besides TCM that utilize completely different points, most notably Master Tung’s acupuncture. There are also many different Korean, Japanese, Tibetan and Vietnamese (to name a few) styles of acupuncture, which utilize different points than TCM acupuncture. So what one person calls a “sham” acupuncture point, others may utilize for “real” treatments.

These two reasons may partly explain why in our study, and in most studies that use this type of sham acupuncture, the sham treatments do show a positive effect. In our study, the effects of sham acupuncture were not as strong or as long-lasting as the beneficial effects of real acupuncture, but there is still an effect. Skeptics of acupuncture use these kinds of findings to say things like: “it doesn’t matter where you stick the needles”, “there’s only an effect because of the attention you are paying to the patient” and “the theories of Chinese medicine are bogus”.

Obviously we don’t agree with the skeptics and while we feel that acupuncture research is important and it has its place, for us the proof is in the pudding of daily practice.