Acupuncture Can Be Used For Supportive Oncology Care

Acupuncture is a branch of TCM (Traditional Chinese Medicine) and is a therapeutic modality that’s been developed for thousands of years. Treatment involves the insertion of needles at chosen points on the body, followed by heat therapy, handling with physical forces, heat, or, in modern times, electrical stimuli. Based on the theory of TCM, Chi or Qi (vital energy) circulates all over the body along channels known as meridians. It was thought that the obstruction or interruption of Qi makes a person susceptible to illness. Placement of needles at certain points along the meridian is deemed to normalize the flow of energy that results in a therapeutic effect.

The theories of meridians and Qi do not jibe with our current knowledge of human physiology and anatomy. Nevertheless, studies support acupuncture’s clinical effects. New neuroscience studies indicate that it appears to work by balancing the nervous system. The meridians and Qi, therefore, can be considered as metaphors to explain the clinical reactions during acupuncture treatment as observed by practitioners of TCM.

First, the acupuncturist interviews the patient during a treatment, then conducts an examination based on the teachings of TCM, specifically concentrating on the appearance of the tongue and qualities of the pulse, and then comes up with a TCM diagnosis. Typically, the diagnosis is a description of a malady pattern instead of a pathological opinion. The diagnosis determines the acupuncture points to be used.

The acupuncture points (acupoints) on the body are identified and the skin is cleaned. A metal tube is used to guide the needle into the identified point. The top of the needle is applied with a gentle tap to help the needle penetrate the skin. The metal tube is afterwards removed, and the needle is pushed to the desired depth by means of a gentle pushing and twisting motion. The acupuncturist may see it fit to apply electrical stimuli or heat to the needle. Traditionally, heat is provided by acupuncturists via moxibustion, a burning of an herb (Artemisia vulgaris), or now, by a heat lamp. Some acupuncturists connect a small electric pulse-generating device to each needle, to enhance the activation of the acupoints, as of the latter part of the 20th century. This technique is termed “electro-acupuncture.” As a medical device, the acupuncture needles are regulated in the United States. They are very thin (28 – 40 gauge), filiform, about as thin as a human hair, single-use, and sterile. The needles are often forged out of stainless steel and are individually packaged in a guide tube.

How Is Acupuncture Used Today?

Acupuncture was traditionally used to treat and prevent a lot of ailments. Only in the last few decades has its effectiveness been closely investigated with rigorous scientific research methodology, when its clinical efficacy for specific indications, possible mechanisms of action, and physiologic effects have been documented. In controlled randomized clinical trials acupuncture in Encino has been shown to be highly efficacious for vomiting, nausea, pain, and other symptoms. In Western countries, acupuncture is probably the most widely used TCM modality, mainly because of its growing body of research. This treatment can induce measurable, neurophysiologic, and objective changes in both humans and animals.

The last decade saw acupuncture as being more and more integrated into Western conventional cancer care in the US. There is an integrative medicine component that a lot of community hospitals and major comprehensive cancer centers utilize and this usually includes acupuncture as a mode of supportive care. Actually, this treatment isn’t used as a treatment for disease. Qualified practitioners who usually are also medical doctors offer acupuncture.

Is There Evidence for Acupuncture’s Use in Cancer Care?

When it comes to directly affecting the cancer itself, there is no evidence of acupuncture works hence it is never used to treat cancer. Clinical studies, however, reveal that it can decrease a lot of the important emotional and physical symptoms cancer patients commonly suffer from, which greatly improves the quality of life of the patients.

Pain

The best and most commonly-studied use for acupuncture is for the relief of pain. There is significant proof supporting acupuncture’s potency from studies dealing with arthritic pain, lower back pain, and headache. It appears that acupuncture also works in relieving cancer-related pain, although with lesser proof. A placebo-controlled, randomized clinical trial observed the efficacy of auricular acupuncture on patients experiencing pain who are taking regular medication. For one month, needles were stuck into selected acupoints on the patients’ ears. The severity of the pain lessened after two months by 36% from baseline in the treatment group. This was a significant difference compared to the two control groups in the study who experienced very little improvement. The outcomes were due to the fact that the some patients also suffered from neuropathic pain, a type of pain that rarely responds to standard treatment.

Cancer patients suffering from other painful conditions have also been studied. Patients with breast cancer, for example, taking aromatase inhibitors often have to cope with joint pain. A controlled randomized trial analyzed full-body and auricular acupuncture treatment for arthralgia induced by aromatase-inhibitor in breast cancer patients. Randomized real or sham acupuncture was administered on 51 postmenopausal women two times a week for six weeks. The worst pain-related functional interference, pain severity, and pain scores were significantly decreased by real versus sham acupuncture treatment.

CINV or Chemotherapy-induced nausea and vomiting is another highly studied indication for acupuncture. In one study, 104 patients suffering from breast cancer undergoing highly emetogenic chemotherapy were randomized to either get electro-acupuncture once a day for 5 days at the ST36 and PC6 acupoints (found on the leg and forearm, respectively), pharmacotherapy alone, or minimal needling at non-acupoints. The same triple pharmacological agents for emesis management were given to all patients: intravenous diphenhydramine hydrochloride, lorazepam, and prochlorperazine. The number of episodes of total emesis significantly went down via electro-acupuncture when compared with standalone medication. After 6 – 14 days during the follow-up period, when groups no longer received acupuncture, the difference in emesis episodes essentially vanished.

Acupuncture is strongly recommended for the treatment of acute CINV, based on a lot of systematic reviews. In the trials, different acupuncture regimens were used in the trials. This ranged from once a day on the day of chemotherapy and the day after, to electrical stimulation per two hours for five days. The studies were mostly performed on patients who were undergoing highly emetogenic chemotherapy.

Some insurance plans do cover CINV management by means of acupuncture. The wide consensus indicates that electro-acupuncture works much better than manual acupuncture that in turn, works a lot better than acupressure (using manual pressure instead of needles to elicit nerve stimulation).

Hot Flashes

Patients suffering from prostate or breast cancer patients undergoing hormonal therapy treatment may develop intense hot flashes that can disrupt their normal daily activities. However, androgen or estrogen therapy, the conventional therapy for hot flashes, is contraindicated in cancer patients with cancer. A lot of uncontrolled studies indicate that acupuncture can lessen hot flashes in patients suffering from prostate or breast cancer. Acupuncture controlled studies, in this setting reveals ambiguous result.

Xerostomia

The salivary glands can be damaged can be damaged by radiation therapy to the neck and head, and a lot of neck and head cancer patients consequently suffer from persistent xerostomia (dry mouth). These symptoms can be alleviated using acupuncture treatment. In a randomized, controlled trial of patients with head and neck cancer who experienced pain and dysfunction neck dissection, 58 patients received either usual care (eg, anti-inflammatory drugs, analgesia and/or physical therapy for four weeks. Pain was significantly reduced and the function of shoulder and neck muscles was greatly boosted through acupuncture. Some patients suffering from extreme dry mouth benefited greatly, especially those with severe dry mouth. The neuronal matrix that was possibly involved was studied in a mechanistic study that used fMRI or functional magnetic resonance imaging. In this trial which was controlled and randomized, acupuncture was connected with the bilateral activation of the adjacent operculum and insula, modifications not evidenced in sham acupoint treatment. In addition, real acupuncture induced greater production of saliva compared to sham acupuncture. Some health experts may argue that a trial course of acupuncture (one or two times a week for four weeks) is worth doing on patients suffering from severe dry mouth which medications cannot address. After a month, if no clinical improvement is seen, then acupuncture is unlikely to work for that specific patient.

Possible Risks

When performed by qualified practitioners, acupuncture is generally safe. A light pricking of the needle followed by a sore or a heavy sensation at the site is usually felt. A sharp pain means that the needle is placed in an incorrect position. The needles are removed 30 minutes to an hour later. After the treatment, there is usually no loss of blood or obvious sign of skin penetration at the site.

The most common minor side effects of acupuncture treatment include needle pain and localized bleeding. Some of its rarer side effects include pneumothorax, asthma attack, vasovagal reaction, hypertensive crisis, and exacerbation of depression.

It is very important that patients only seek treatment from acupuncturists who are professionally trained, properly credentialed, and experienced in treating people with cancer. The acupuncturist needs to follow hygienic practices like applying clean needle techniques and use universal precautions, and special safety precautions for cancer patients undergoing treatment.

Points to Consider

Special safety precautions associated with acupuncture are required when dealing with cancer patients. Those patients who are under active treatment may be very susceptible to bleeding or infection. Cancer treatment and the cancer itself may have affected anatomical structures making needling certain acupoints inadvisable. These people should not receive any type of acupuncture treatment:

• People suffering from a new onset of cardiac arrhythmia
• People with INR greater than 4.0
• People with platelets less than 20,000/µL
• People with absolute neutrophil count less than 500/µL
• People with recent organ or stem cell transplantation

Acupuncture should not be performed at the site of the metastatic or primary neoplasm; it should not be administered on patients who have an open wound, fistula, active infection, who have recently undergone treatment with radiotherapy or who are wearing medical device/prosthesis.

In the United States, the national organization that validates entry-level competency in the practice of acupuncture and Oriental medicine through professional certification is the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine). Acupuncture can also be provided by podiatrists, dentists, and chiropractors in some states. They may not have received additional acupuncture training.

Bottom-Line

Being a complementary mode of treatment, acupuncture can be usefully integrated as an adjunct to supportive oncology care. Although directly, it may not cure cancer, it has the power to alleviate a lot of the common symptoms experienced by cancer patients. Current studies support its use in CINV and the relief of pain. Other studies indicate that is may also ameliorate radiation-induced dry-mouth, although this benefits requires further research.

Acupuncture has a good safety record when conducted by qualified acupuncturists and is best used as part of a multimodality treatment approach. When treating cancer patients, practitioners need to adopt special safety precautions.

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