Acupuncture as a Treatment Within Integrative Health for Palliative Care: A Brief Narrative Review of Evidence and Recommendations

Abstract

Background: Acupuncture is one of the fastest developing evidence bases in Complementary Medicine and is one of the leading therapies included within integrative health care. This narrative review includes two separate parts: the first is about evaluation of the current evidence status in reviews on acupuncture and the second examines and gives examples of available recommendations on acupuncture in treatment guidelines from health care experts and public health organizations recommending acupuncture as a viable treatment in patients in palliative care. Methods: Electronic searches were performed in PubMed using the terms ''acupuncture'' + ''palliative'' and adding the term ''safety'' to find review articles documenting safety and evidence of effectiveness of acupuncture for treatment of symptoms in palliative care patients. Treatment guidelines that recommend use of acupuncture for symptom control in palliative care were found by searching through a database currently under construction by the lead author. Results: Acupuncture shows emerging evidence for 17 indications in palliative care. Examples were found and presented of publications recommending acupuncture for treatment of symptoms for patients in palliative care from Government, public health, oncology, and medical expert sources. The most publications are in oncology, but other conditions were found and a number were found in pediatric care. Conclusions: While the evidence for use of acupuncture to treat symptoms in palliative care patients is relatively weak, the evidence base is growing. Experts worldwide are also increasingly recommending acupuncture as a treatment for symptoms in palliative care. Since acupuncture is a safe, nonpharmacological treatment but with small, clinically significant effects, these recommended uses appear as pragmatic efforts to bridge the gap of treatment options available to this patient group.

Implementation of Acupuncture in Routine Oncology Care: A Comparison of Physicians’, Nurses’, Physiotherapists’ and Acupuncturists’ Practice and Beliefs

“…19,43 If there are no better alternatives, acupuncture may be valuable to many patients despite the rather weak scientific evidence regarding genuine acupuncture effects. 3,9,20,21 Although different studies of acupuncture for cancer-related symptoms present conflicting results [3][4][5] and indicate great expectancy-driven effects, [3][4][5]12,13,23 patients often present self-perceived benefits from acupuncture treatments for cancer related symptoms. 13,23,43 Reasonably, effects from positive tations, communication, touch, and relaxation during acupuncture therapy, may be valuable for the patients.…”

“…Plausibly their valuing is based on research on acupuncture for cancer-related symptoms. [3][4][5]13,[19][20][21] The conclusions to be drawn vary highly depending on whether the studies compare the effect of acupuncture to the effect of no acupuncture (often demonstrating great effects 22,23 ), or if the comparison alternative is a sham device (often demonstrating minor or no effects 4,13 ). Accordingly, it seems reasonable that differences in interpretation of scientific studies produce differences in beliefs within different professionals of the oncology team.…”

“…All individual oncology professionals thus estimate their own competence and make their individual acupuncture treatment decisions, commonly based on papers reviewing the scientific evidence for effects of acupuncture in cancer related symptoms. [3][4][5]13,[19][20][21] Acupuncturists (ie, not licensed health care professionals) practicing acupuncture within private alternatives have no scientific evidence-based restrictions; they work outside the publicly financed "approved health care." However, they are prevented from using acupuncture to cure cancer per se, and to treat children (<12 years).…”

Reframing Palliative Care: An East-West Integrative Palliative Care Model

“…Currently, there is growing evidence for use of acupuncture for symptom management in palliative care for 17 indications, though weak. (37) Despite the absence of strong evidence, experts increasingly recommend the use of acupuncture for treatment of symptoms because of its safety profile. In cancer care, patients often present with symptom clusters of multiple co-occurring complaints (pain, fatigue, sleep disturbance) and acupuncture can be targeted to addressing the entire symptom cluster.…”

Acupuncture for postoperative pain of lumbar disc herniation: A systematic review and meta-analysis

“…Acupuncture, a standard nonpharmacological treatment by stimulating specific acupoints on the body, has been widely used for various diseases, especially those involving multiple painful disorders. [ 11 , 12 ] Acupuncture can regulate neuroendocrine function by stimulating acupoints, such as increasing the production of endogenous opioid peptides to achieve analgesic effects. [ 13 ] Allodynia is a common symptom in patients with neuropathic pain.…”