Abstract
Objective The purpose of this study was to systematically evaluate the efficacy and safety of acupuncture combined with the WHO three-step analgesic drug ladder for cancer pain. Methods The Cochrane Library, PubMed, and CNKI Database of Systematic Reviews were searched. Using the Cochrane Register for Randomized Controlled Trials, the quality of the included literature was evaluated, and the meta-analysis was carried out with RevMan 5.3 software. Results Compared with three-step analgesia alone, acupuncture combined with three-step analgesia for cancer pain increased pain relief response rates (RR = 1.12, 95% CI: 1.08∼1.17, P < 0.00001), reduced NRS score (SMD = −1.10, 95% CI: −1.86∼−0.35, P=0.004), reduced the rate of side effects (RR = 0.45, 95% CI: 0.38∼0.53, P < 0.00001), including nausea (P < 0.00001), vomiting (P=0.008), constipation (P < 0.00001), and dizziness (P=0.010), reduced the burst pain rate (SMD = −1.38; 95% CI: −2.44∼−0.32, P=0.01), shortened analgesia effect onset time (P=0.004), and extended the duration of response (P < 0.0001). Conclusion For the treatment of cancer pain, acupuncture combined with three-step analgesic drugs is better than using only three-step analgesic drugs.
Highlights
Pain is one of the most debilitating symptoms experienced by patients with advanced cancer
The treatment of cancer pain mostly utilizes the three-step “ladder” treatment principle proposed by the WHO, where mild, moderate, and severe pain are treated with nonsteroidal anti-inflammatory drugs (NSAIDs), weak opioids, and strong opioids, respectively [4]
Patients received acupuncture treatment for 1 to 3 weeks, for durations of 20 to 60 min per session. e evaluation criteria for the curative effect were similar across studies. e objective outcome measures were treatment response rate, numerical rating scale (NRS), side effect rates, times of burst pain, onset time to analgesic effect, duration of response (DOR) (h), quality of life (QOL), Karnofsky performance status (KPS), and quality of life questionnaires (QLQ-C30). e minimal important difference (MID) refers to the change in the score of the smallest efficacy evaluation questionnaire recognised by the patient
Summary
Pain is one of the most debilitating symptoms experienced by patients with advanced cancer. The treatment of cancer pain mostly utilizes the three-step “ladder” treatment principle proposed by the WHO, where mild, moderate, and severe pain are treated with nonsteroidal anti-inflammatory drugs (NSAIDs), weak opioids, and strong opioids, respectively [4]. One primary reason why cancer pain is difficult to control is because cancer pain patients cannot tolerate the side effects of analgesics. Various acupuncture treatments can be combined, with no risk of addiction, no side effects, convenient application and at a low cost, demonstrating the unique advantages of TCM in the treatment of cancer pain [7]. Erefore, it is necessary to use a systematic evaluation method to rigorously evaluate the randomised controlled study of acupuncture combined with three-step analgesic drugs to treat cancer pain, to assess its exact effect in the treatment of cancer pain In the Evidence-Based Complementary and Alternative Medicine last 20 years, there have been many clinical reports on the utility and safety of acupuncture for the treatment of cancer pain, and acupuncture therapy is a widely recognised alternative measure for the treatment of cancer pain. erefore, it is necessary to use a systematic evaluation method to rigorously evaluate the randomised controlled study of acupuncture combined with three-step analgesic drugs to treat cancer pain, to assess its exact effect in the treatment of cancer pain
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