Acupuncture for Treatment of Arthralgia Secondary to Aromatase Inhibitor Therapy in Women with Early Breast Cancer: Pilot Study

Abstract

Background Aromatase inhibitors (AIs) are recommended as adjuvant hormone treatment for postmenopausal women with early breast cancer. A substantial proportion of women taking AIs experience joint pain and stiffness. Studies have suggested that acupuncture may be effective in treating joint pain. Objective A pilot study was conducted to evaluate the feasibility, safety and efficacy of using acupuncture to treat AI-induced arthralgia. Methods A total of 32 patients were randomised to receive either sham or real electroacupuncture (EA) twice weekly for 6 weeks. Outcomes of joint pain, stiffness and physical function were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), overall pain severity and interference with the BPI-SF and quality of life (QOL) with the Functional Assessment of Cancer Therapy-General (FACT-G) instrument. Hand strength was assessed by a grip test, and a serum marker of inflammation (C reactive protein (CRP)) was also measured. All assessments were performed at baseline, 6 weeks and 12 weeks, except for blood samples at baseline and 6 weeks only. Results No serious adverse events were reported during or after acupuncture treatments. There were no significant differences in outcome measures. However, positive trends were observed in stiffness and physical function at week 12 in favour of real EA. Conclusions Findings suggest that acupuncture is feasible and safe in patients with breast cancer with joint pain caused by AI. A larger study with adequately powered to confirm these results and detect clinically relevant effects is needed.

Management of aromatase inhibitor induced musculoskeletal symptoms in postmenopausal early Breast cancer: A systematic review and meta-analysis

“…Out of 17 RCTs, only 11 could be adequately assessed for methodological quality, as the rest were only published in abstract form. Of the 11 assessable RCTs, eight studies had a high Jadad score ≥3 (26)(27)(28)(29)(30)(31)(32)(33). Three studies scored poorly on the Jadad scale for methodological quality (34)(35)(36).…”

“…There were five RCTs, three of which investigated the use of acupuncture (31,32,34) and two of which investigated the use of electro-acupuncture (28,29). There was also one single-arm pilot study, which investigated the use of electroacupuncture (42).…”

“…The primary outcome of all the studies included change in pain scores after the intervention. One study also listed primary outcomes as perceived benefit of acupuncture, hand strength and inflammatory markers (ESR and CRP) (28). Two studies could be included in the method of meta-analysis, as they used the same scoring systems within their studies (29,31).…”

“…Of the RCTs, three studies investigated true acupuncture/electro-acupuncture versus sham acupuncture (28,31,32); one study had three arms consisting of true electro-acupuncture, sham electro-acupuncture and a waitlist control (29) and one trial was a crossover design, investigating acupuncture versus observation, then crossover after six weeks (34). The methods of sham acupuncture differed between trials, with some trials using sham, non-penetrating needles on real acupuncture points (28), and others using sham, non-penetrating needles at non-acupuncture, non-trigger points (29,32). Crew et al (31), used superficial needle insertion at non-acupuncture points as the control.…”

Issues associated with Aromatase Inhibitor–Associated Musculoskeletal Symptoms in Breast Cancer

“…Pain score assessment includes the Brief Pain Inventory-Short Form (BPI-SF) [20][21][22] ; Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) [21,23] ; Functional Assessment of Cancer Therapy-General (FACT-G), and the Handgrip strength test [20,21] . In objective measurement, some studies check the cytokine level as IL-1,IL-6, IL-8,IL -10,IL -12,IL -17; IFN-β; TNF-ά compared to the degree of inflammation [24] or the estradiol change because estrogen is associated with chondroprotective effects through decreasing collagen degradation [12] .…”