Acupuncture—Acupuncture, acupressure, and electroacupuncture are forms of traditional Chinese medicine in which physical manifestations of the meridians (eg, joint pain) are assessed, and
qi is facilitated or rebalanced. Pressure on meridian points can be exerted by insertion of small-gauge needles (eg, acupuncture) or a combination of needles and low-frequency electric current (electroacupuncture), or by manual pressure with a finger (acupressure).
30 Auricular acupuncture is acupuncture of the ear, thought in traditional Chinese medicine to contain points connected to internal organs.
32 Physicians trained in Western medicine and acupuncture are more likely to take a pragmatic approach and stimulate trigger points, tender points, or a mixture of segmental points appropriate to a disordered segment, though these referral patterns often resemble traditional meridian lines.
32 Some evidence indicates that effects of acupuncture are due to release of multiple endogenous substances (eg, oxytocin, sterioids, endorphins) that no single drug treatment could mimic.
32Acupuncture has been found to help manage a wide variety of pain conditions. Evidence is particularly strong for acupuncture in acute pain, though limited evidence exists for postprocedure pain in patients with cancer. Filshie and Thompson
32 reported that a majority of 250 patients with gynecologic cancer had enhanced analgesia when acupuncture was administered as an adjunct to anesthesia. A randomized controlled trial of auricular acupuncture for patients with cancer found substantial pain reduction in patients receiving acupuncture compared with those receiving placebo.
33Acupuncture for cancer pain caused by primary or metastatic lesions has been studied, but most reports are retrospective and lack control groups.
34-36 Two reviews of 339 patients with advanced cancer showed that 52% and 56% of patients, respectively, benefited from increased analgesia following three weekly acupuncture treatment sessions.
34,35 In these studies, mobility, cancer treatment–related pain, muscle and bladder spasms, and vascular problems improved. Auricular acupuncture has also shown an analgesic effect in patients with cancer pain.
33,37In addition to alleviating cancer pain, acupuncture has been used to treat patients with radiation-induced xerostomia,
38,39 as well as patients with cancer-related conditions such as shortness of breath caused by a primary or secondary malignancy,
40 patients with lower extremity edema secondary to intrapelvic lymph node dissection for malignant gynecologic tumors,
41 and women with menopausal symptoms on tamoxifen therapy after previous breast cancer.
42 Acupuncture has improved upper extremity mobility following axillary lymphadenectomy.
43Side effects of acupuncture, acupressure, and electroacupuncture are generally limited to minor bruising or irritation at the point of contact.
44 Acupuncture is contraindicated in the local area of an unstable spine, in persons with severe clotting disorders or neutropenia, and on limbs with lymphedema.
45 Additionally, semi-permanent needles, placed with tape for days at a time are contraindicated for patients with valvular heart disease.
46