Acupuncture for aromatase-inhibitor joint pain
Joint pain and stiffness are the main reason women stop aromatase-inhibitor tablets early. In a large randomised trial, twelve weeks of acupuncture reduced that pain more than sham needling or no treatment, and the benefit lasted after the sessions ended.
Overview
The SWOG S1200 trial (Hershman et al., JAMA 2018) randomised 226 postmenopausal women with early breast cancer and aromatase-inhibitor arthralgia to true acupuncture, sham acupuncture or waitlist control for six weeks twice weekly then six weekly maintenance sessions. At six weeks the mean worst-pain score fell by 2.05 points with true acupuncture versus 1.07 with sham and 0.99 with waitlist on a 0 to 10 scale; the difference against sham was statistically significant and persisted at 24 and 52 weeks. Adverse events were minor bruising. The 2022 SIO-ASCO pain guideline recommends acupuncture for aromatase-inhibitor-related joint pain, the only complementary therapy to receive a firm recommendation for a specific cancer-treatment pain syndrome. Whether it improves persistence with endocrine therapy, and therefore recurrence, has not been shown.
How it works
Needling at standard and joint-specific points modulates central pain processing and local inflammation; a sham-needle arm controls for expectation, and the true-acupuncture arm still outperformed it.
- Multicentre randomised trial with a sham arm
- Effect maintained a year after treatment
- Firm SIO-ASCO 2022 recommendation
- Access and cost of a course of sessions
- Not yet shown to improve adherence to endocrine therapy
- Effect size against sham is modest
Latest papers
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