Randomized, Blinded, Sham-Controlled Trial of Acupuncture for the Management of Aromatase Inhibitor-Associated Joint Symptoms in Women With Early-Stage Breast Cancer

Crew, K. D.

Capodice, J. L.

Greenlee, H.

Brafman, L.

Fuentes, D.

Awad, D.

Tsai, W. Y.

Hershman, D. L.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology

2010

28(7)

1154-1160

RCT

Pain

Arthralgia

RCT

Acu Versus Sham

Acupuncture

Auricular Acupuncture

Semi-Individualized Acupuncture Protocol

Sham Control

Penetrating Sham

Superficial Needling Depth

Sham Acupoint Control

Symptom Based Point Selection

Restricted Modalities, Acupuncture Only

Breast Cancer

Aromatase Inhibitor Therapy

PURPOSE: Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience joint symptoms that can lead to discontinuation of effective therapy. We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC. METHODS: We conducted a randomized, controlled, blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs. TA included full body/auricular acupuncture and joint-specific point prescriptions, whereas SA involved superficial needle insertion at nonacupoint locations. Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks. RESULTS: Of 51 women enrolled, 43 women were randomly assigned and 38 were evaluable. Baseline characteristics were comparable between the two groups. Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks, which was lower for TA compared with SA (3.0 v 5.5; P < .001). We also found differences between TA and SA in pain severity (2.6 v 4.5; P = .003) and pain-related interference (2.5 v 4.5; P = .002) at 6 weeks. Similar findings were seen for the WOMAC and M-SACRAH scores. The acupuncture intervention was well-tolerated. CONCLUSION: Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness, which was not seen with SA. Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect.

Pain

>1/WK

43

6 Weeks