Abstract
Background Cancer-induced bone pain (CIBP) is a highly prevalent symptom, which afflicts vast majority of patients who suffer from cancer. The current treatment options failed to achieve satisfactory effect and the side effects were prominent. Recent randomized controlled trials (RCTs) of animal demonstrate the benefit of acupuncture for CIBP. We sought to determine if the pooled data from available RCTs supports the use of acupuncture for CIBP. Methods A literature search for randomized controlled trials was conducted in six electronic databases from inception to May 31, 2019. Meta-analysis was performed with Review Manager 5.3 software; the publication bias was assessed by Stata 12.0 software. We used random effects model for pooling data because heterogeneity is absolute among studies to some extent. Results Twenty-four trials were included in the review, of which 12 trials provided detailed data for meta-analyses. Preliminary evidence indicates that compared to wait list/sham group, acupuncture was effective on increasing paw withdrawal threshold (PWT) and paw withdrawal latency (PWL). Compared to medicine, acupuncture was less effective on PWT, but as effective as medicine on PWL. Acupuncture can reinforce medicine's effect on PWT and PWL. Compared to the control group, acupuncture was superior to increase body weight (BW), decrease spinal cord glial fibrillary acidic protein (GFAP), and interleukin-1β (IL-1β). Furthermore, some studies showed acupuncture delay or partially reverse morphine tolerance. Three studies found acupuncture has no effect on PWT, but 2 of them found acupuncture could enhance small dose of Celebrex's effect on CIBP. Conclusions Acupuncture was superior to wait list/sham acupuncture on increasing PWT and has no less effect on increasing PWL compared to medicine; acupuncture improved the efficacy of drugs, increased the CIBP animals' body weight, and decreased their spinal cord GFAP and IL-1β. High-quality studies are necessary to confirm the results.
Highlights
Cancer-induced bone pain (CIBP) refers to bone pain caused by primary bone neoplasm or secondary to other carcinomas
A total of 723 articles were identified with the search terms. 82 duplicates were omitted, and the left 641 publications were screened. 564 studies were excluded for at least one of the following reasons after title and abstract were screened: (1) the intervention did not include acupuncture; (2) the stimulation site was not at the acupoint; (3) the model was not cancer-induced bone pain; (4) they were not animal studies; (5) they were reviews or case reports or letters; (6) the outcomes did not include paw withdrawal threshold (PWT)/paw withdrawal latency (PWL)/body weight (BW)/ glial fibrillary acidic protein (GFAP)/IL-1β; and (7) they did not include a usual-care and/ or placebo comparison group. 77 articles remained after initial reading. en, we read the full papers: 53 papers were excluded and 24 articles met the inclusion criteria (Figure 1)
By reading the full texts of the included studies, we found some studies investigating acupuncture effects from various aspects, so they were divided into more than one randomized controlled trials (RCTs) according to their arms
Summary
Cancer-induced bone pain (CIBP) refers to bone pain caused by primary bone neoplasm or secondary to other carcinomas It is a highly prevalent symptom, which afflicts vast majority of patients who suffer from cancer [1]. Preliminary evidence indicates that compared to wait list/sham group, acupuncture was effective on increasing paw withdrawal threshold (PWT) and paw withdrawal latency (PWL). Compared to the control group, acupuncture was superior to increase body weight (BW), decrease spinal cord glial fibrillary acidic protein (GFAP), and interleukin-1β (IL-1β). Acupuncture was superior to wait list/sham acupuncture on increasing PWT and has no less effect on increasing PWL compared to medicine; acupuncture improved the efficacy of drugs, increased the CIBP animals’ body weight, and decreased their spinal cord GFAP and IL-1β.
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