Zeng, K., Dong, H., Chen, H., Chen, Z., Li, B., & Zhou, Q. (2014). Wrist-ankle acupuncture for pain after transcatheter arterial chemoembolization in patients with liver cancer: A randomized controlled trial. American Journal of Chinese Medicine, 42, 289–302. 

To evaluate the effects of wrist and ankle acupuncture for analgesia after transcatheter arterial chemoembolization

Patients receiving transcatheter arterial embolizations (TACEs) for primary liver cancer were randomized to receive acupuncture or opioids for pain management after the procedure. Pain scoring was done immediately after the procedure, and interventions were initiated after initial pain scoring. Pain scoring was repeated at one, two, four, and six hours after the intervention. Patients receiving opioids were given a single dose of MS Contin after the procedure. Those given acupuncture had needles remaining in subcutaneous tissue for six hours and did not receive analgesics during that time.

• N = 60  
• MEAN AGE = 51.4 years
• MALES: 91.6%, FEMALES: 8.4%
• KEY DISEASE CHARACTERISTICS: Liver cancer

• SITE: Single site  
• SETTING TYPE: Inpatient    
• LOCATION: China

• PHASE OF CARE: Active antitumor treatment

Randomized, controlled trial with active control

• Visual Analog Scale (VAS) for pain severity
• Pain remission was used in the statistical analysis (complete remission, partial, mild, or no remission). Pain intensity difference was calculated to create a pain relief variable (PAR) where PAR = intensity difference/pretreatment pain score. A PAR > 50% was considered partial remission, and a PAR < 50% was considered mild.

At one, two, and four hours postprocedure, both groups experienced similar pain relief. After six hours, the acupuncture group experienced significantly better pain relief (p < 0.05) as indicated by the proportion that obtained complete and partial remission. There were no differences between groups in adverse events.  

Wrist and ankle acupuncture was effective for the reduction of acute pain in this group of patients after TACE.

• Small sample (< 100)
• Risk of bias (no blinding)
• Other limitations/explanation: Limited duration of follow up; measures ended at six hours although postprocedural pain can persist for a few days

The findings of this study suggested that wrist and ankle acupuncture can provide effective analgesia for acute pain related to TACE. Wrist and ankle acupuncture is a technique that differs in practice and theory from traditional acupuncture in that it does not create a needling sensation. Acupuncture may be helpful for some patients to manage acute pain, and it may be a useful alternative for postprocedural pain control for patients who should avoid medication and medication side effects.