Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor‐related arthralgia: A randomized trial

Abstract

Purpose Although fatigue, sleep disturbance, depression, and anxiety are associated with pain in breast cancer patients, it is unknown if acupuncture can decrease these co-morbid symptoms in cancer patients with pain. This study aimed at evaluating the effect of electro-acupuncture on fatigue, sleep, and psychological distress in breast cancer survivors who experience joint pain related to aromatase inhibitors (AIs). Patients and methods We performed a randomized controlled trial of an eight-week course of electro-acupuncture (EA) as compared to waitlist control (WLC) and sham acupuncture (SA) in postmenopausal women with breast cancer who self-reported joint pain attributable to aromatase inhibitors. Fatigue, sleep disturbance, anxiety, and depression were measured by the Brief Fatigue Inventory (BFI), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HADS). The effects of EA and SA vs. WLC on these outcomes were evaluated using mixed-effects models. Results Of the 67 randomly assigned patients, baseline pain interference was associated with fatigue (Pearson correlation coefficient r =0.75, p<0.001), sleep disturbance (r=0.38, p=0.0026), and depression (r= 0.58, p<0.001). Compared to the WLC, EA produced significant improvement in fatigue (p=0.0095), anxiety (p=0.044), and depression (p=0.015) and non-significant improvement in sleep disturbance (p=0.058) during the 12 week intervention and follow up period. In contrast, SA did not produce significant reduction in fatigue and anxiety symptoms, but produced significant improvement in depression compared with WLC (p=0.0088). Conclusion Compared to usual care, EA produced significant improvement in fatigue, anxiety, and depression, whereas SA improved only depression in women experiencing AI-related arthralgia. Clinical Trial Registration NCT01013337

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).…”

“…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.…”

“…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). There was significant between-study heterogeneity for the effects of acupuncture on BPI-SF worst pain score (I 2 =79%).…”

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

“…One unique case report proposed Kampo medicines (Japanese traditional medicines) may improve AIs-induced side-effects [35] Other complementary therapies include Tai chi, which was demonstrated to improve wellbeing for breast cancer patients with AI related arthralgia [36] ; yoga, leading to improvement in objective functional outcomes, pain, and health-related quality of life as measured by the Brief Pain Inventory (BPI), self-reported Patient Specific Functional Scale (PSFS) [37,38] ; and electro-acupuncture, which will be exclusively discussed in the following paragraph [22,39,40] .…”