Paley, C.A., Johnson, M.I., Tashani, O.A., & Bagnall, A.M. (2011). Acupuncture for cancer pain in adults. Cochrane Database of Systematic Reviews, 1, CD007753.

To evaluate the efficacy of acupuncture for the relief of cancer-related pain in adults

Databases searched were Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Allied and Complementary Medicine Database (AMED), SPORTDiscus, and PsycINFO.

Search keywords included acupuncture therapy, Medicine East Asian traditional, acupressure or acupoint*, traditional Chinese medicine, pain, neoplasm or cancer. All databases were searched from their inception to October 2010. Authors provided an extensive list of search terms and the strategy per database. In addition, to identify further references for analysis, investigators searched the reference lists of eligible studies as well as lists associated with previous systematic reviews.

Studies were included if they

• Were randomized controlled trials (RCTs).
• Evaluated any type of invasive acupuncture. (Both Western-style and traditional Chinese acupuncture were included in the search.)
• Involved patients who had cancer-related pain as defined by commonly used rating scales or questionnaires.
• Involved patients 18 years of age or older.

Studies were excluded if they were not RCTs or if they involved pain due to preexisting noncancer pathology or treatments (e.g., chemotherapy), neuropathic pain, or procedures such as surgery.

The initial search retrieved 253 articles. Of these, only three RCTs were appropriate for inclusion. None provided extractable data for meta-analysis. Investigators evaluated study quality by using the Jadad scale. Two of the three studies had low-quality scores (2 points out of 5).

The three studies included a total of 204 patients. Across studies, sample size range was 48–90. Authors reported no other sample characteristics.

• One study compared the effects of auricular acupuncture at acknowledged acupuncture points to acupuncture at placebo points. Compared to the placebo group, the acupuncture group reported a significant decrease in pain intensity (p < 0.0001), compared to baseline, at two months.
• One study concluded that the analgesic effect of acupuncture was greater than that of medication (p < 0.05). However, in this study researchers set a predetermined level of pain as the criterion for general effectiveness; researchers did not analyze actual pain data. The study did not report raw data or standard deviations.
• One study reported that long-term effects were similar in groups treated with acupuncture and medication. The study provided no explanation regarding pain measurement.
• The evidence from only one high-quality RCT was insufficient to provide the basis for a judgment about the efficacy of acupuncture. This study involved apparent inconsistencies in reporting and some inadequate acupuncture doses.

This study provided insufficient evidence to determine the effectiveness of acupuncture for the relief of cancer-related pain.

Available evidence is inconclusive or of low quality.

Acupuncture is being more widely used to treat cancer-related pain, but evidence is insufficient to support the effectiveness of this treatment. More well-designed studies of acupuncture are needed, and study designers should ensure adequate sample sizes, homogeneity of cancer pain conditions under study, consistent dosing of acupuncture, valid controls, and reliable pain outcomes measurement. The authors point out that guidelines for the use of acupuncture are available. They suggest that practitioners use such guidelines and remain aware of the limitations of acupuncture.