In the PEACE study, reported in JAMA Oncology, Jun J. Mao, MD, MSCE, and colleagues found that both electroacupuncture and auricular acupuncture significantly reduced pain severity vs usual care in cancer survivors with chronic musculoskeletal pain. Noninferiority of auricular acupuncture to electroacupuncture was not shown.
As stated by the investigators, “The opioid crisis creates challenges for cancer pain management. Acupuncture confers clinical benefits for chronic nonmalignant pain, but its effectiveness in cancer survivors remains uncertain.”
Study Details
The trial included 360 patients at Memorial Sloan Kettering Cancer Center in New York and five regional suburban sites in New York and New Jersey. Patients were randomly assigned 2:2:1 between March 2017 and October 2019 to receive 10 electroacupuncture treatments over 10 weeks (n = 145), 10 auricular acupuncture treatments over 10 weeks (n = 143), or usual care (n = 72).
The primary outcome measure was change in average pain severity score on the Brief Pain Inventory (BPI; 0–10, with 10 being worst pain) from baseline to week 12. Noninferiority of auricular acupuncture to electroacupuncture was tested if both interventions were superior to usual care. Follow-up was completed in April 2020.
In electroacupuncture, acupuncturists selected four acupuncture points near the pain location and at least four additional points in other body areas to address comorbid symptoms. The four primary points were electrically stimulated using an A3922 E-STIM II device (Tens Plus Industrial Company), with all needles remaining in place for 30 minutes.
“In this randomized clinical trial among cancer survivors with chronic musculoskeletal pain, electroacupuncture and auricular acupuncture produced greater pain reduction than usual care. However, auricular acupuncture did not demonstrate noninferiority to electroacupuncture, and patients receiving it had more adverse events.”— Jun J. Mao, MD, MSCE, and colleagues
Tweet this quote
In auricular acupuncture—a technique in which needle insertion is limited to the ears—up to 10 needles were placed during sessions lasting approximately 10 to 20 minutes, with the needles remaining in place for 3 to 4 days.
Usual care consisted of standard pain management prescribed by clinicians, including analgesic medications, physical therapy, and glucocorticoid injections. Patients in the usual care group were offered 10 acupuncture sessions after week 12.
Key Findings
Mean BPI scores at baseline were 5.2, 5.0, and 5.6 in the electroacupuncture, auricular acupuncture, and usual care groups.
Mean changes in BPI severity scores from baseline at 12 weeks were −0.48 (95% confidence interval [CI] = −0.85 to −0.10) in the usual care group, −2.39 (95% CI = −2.66 to −2.12) in the electroacupuncture group, and −2.03 (95% CI = −2.30 to −1.76) in the auricular acupuncture group.
The difference in change vs the usual care group was −1.92 (95% CI = −2.43 to −1.40) in the electroacupuncture group (P < .001) and −1.56 (95% CI = −2.07 to −1.04) in the auricular acupuncture group (P < .001). The reduction in pain score was 0.36 points greater with electroacupuncture vs auricular acupuncture (95% CI = ∞ to 0.665); since the upper bound of the 95% confidence interval exceeded the predefined noninferiority margin of 0.657 points, noninferiority of auricular vs electroacupuncture could not be claimed (P = .055).
The reduction in pain severity score from baseline persisted in both the electroacupuncture group (−2.19, 95% CI = −2.46 to −1.92) and auricular acupuncture group (−1.99, 95% CI = −2.27 to −1.72) at 24 weeks.
Adverse events were mild to moderate in both acupuncture groups. The most common adverse events were bruising (10.3%) in the electroacupuncture group and ear pain (18.9%) in the auricular acupuncture group. Discontinuation due to adverse events occurred in 1 patient (0.7%) in the electroacupuncture group vs 15 patients (10.5%) in the auricular acupuncture group (P < .001).
The investigators concluded, “In this randomized clinical trial among cancer survivors with chronic musculoskeletal pain, electroacupuncture and auricular acupuncture produced greater pain reduction than usual care. However, auricular acupuncture did not demonstrate noninferiority to electroacupuncture, and patients receiving it had more adverse events.”
Dr. Mao, of the Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, is the corresponding author for the JAMA Oncology article.
Disclosure: This work was supported by the Department of Defense and National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
