Acupuncture versus cognitive behavioral therapy for pain among cancer survivors with insomnia: an exploratory analysis of a randomized clinical trial

Abstract

Pain and insomnia often co-occur and impair the quality of life in cancer survivors. This study evaluated the effect of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on pain severity among cancer survivors with comorbid pain and insomnia. Using data from the CHOICE trial that compared acupuncture versus CBT-I for insomnia among cancer survivors, we analyzed the effect of interventions on pain outcomes in 70 patients with moderate to severe baseline pain. Interventions were delivered over eight weeks. We assessed average pain severity (primary outcome) and pain interference at baseline, week 8, and week 20. We further defined insomnia and pain responders as patients who achieved clinically meaningful improvement in insomnia and pain outcomes, respectively, at week 8. We found that compared with baseline, the between-group difference (-1.0, 95% CI -1.8 to -0.2) was statistically significant favoring acupuncture for reduced pain severity at week 8 (-1.4, 95% CI -2.0 to -0.8) relative to CBT-I (-0.4, 95% CI-1.0 to 0.2). Responder analysis showed that 1) with acupuncture, insomnia responders reported significantly greater pain reduction from baseline to week 4, compared with insomnia non-responders (-1.5, 95% CI -2.7 to -0.3); 2) with CBT-I, pain responders reported significantly greater insomnia reduction at week 8, compared with pain non-responders (-4.7, 95% CI -8.7 to -1.0). These findings suggest that among cancer survivors with comorbid pain and insomnia, acupuncture led to rapid pain reductions, which contributed to a decrease in insomnia, whereas CBT-I had a delayed effect on pain, possibly achieved by insomnia improvement.

Tibetan Herbal Pain-Relieving Plaster for Chronic Musculoskeletal Pain Among Cancer Survivors: Study Protocol of a Randomized, Double-Blind, Placebo-Controlled Trial

“…Pain and comorbid symptoms like insomnia and depression may share common neurobiological pathways ( Finan and Smith 2013 ). Recent studies indicate that nonpharmacologic pain interventions like cognitive behavioral therapy for insomnia or acupuncture may improve both pain and comorbid symptoms via regulating these shared biological pathways ( Yang et al, 2021b ). The present study will also provide insights into the clinical effect of PRP on pain comorbid symptoms that are prevalent in cancer survivors, including emotional distress, fatigue, and insomnia ( Pachman et al, 2012 ).…”

Effect of acupuncture versus usual care on sleep quality in cancer survivors with chronic pain: Secondary analysis of a randomized clinical trial

“…The BPI psychometrics are well established (Cronbach α, 0.80–0.87 for the four pain severity items and 0.89–0.92 for the seven interference items) 30 . Consistent with established definitions of analgesic response based on the BPI, we considered a reduction of 30% or greater on the BPI pain severity score from baseline to 10 weeks to be an analgesic response 18,31 …”

“…18,19 Manual acupuncture has led to rapid pain relief among cancer survivors with insomnia, which contributed to a decrease in insomnia. 18 In patients with breast cancer with aromatase inhibitor-related joint pain, electroacupuncture produced a nonsignificant improvement in sleep quality compared to usual care during the 12-week intervention and follow-up period. 19 Because pain and poor sleep often affect patients with cancer, better characterizing the effect of acupuncture on sleep quality among cancer survivors with pain can help to further inform the delivery of sleep and pain interventions in oncology care.…”

The therapeutic effect of Taijiquan combined with acupoint pressing on the treatment of anxiety insomnia in college students: A study protocol for a randomized controlled trial

“…And then replacing with the next acupoint, each acupoint will be kneaded 1∼2 back and forth, a total of 15 min of continuous pressing. After each treatment, study members should make strict records to ensure the full participation of subjects in the study ( 18 ). Group B does the therapy of Taijiquan combined with acupoint pressing 30 min after waking up, and the treatment procedures and methods are the same as those of Group A.…”