Effects of electroacupuncture and auricular acupuncture for chronic pain in cancer survivors: The PEACE randomized controlled trial.

Abstract

12004 Background: The national opioid crisis has created new challenges in oncology pain management and highlighted an urgent need for non-pharmacological treatments. We evaluated the comparative effectiveness of electro-acupuncture (EA) and auricular acupuncture (AA) versus usual care (UC) for chronic musculoskeletal pain in cancer survivors. Methods: We conducted a randomized controlled trial of cancer survivors experiencing moderate-severe musculoskeletal pain for at least 3 months. EA used a semi-individualized protocol involving electrical stimulation of needles placed in the body. AA used the standardized Battlefield Acupuncture protocol involving up to 10 needles placed in the ears. EA and AA groups received 10 weekly treatments, whereas participants in the UC group received standard care prescribed by their providers. The primary endpoint was average pain severity change measured by the Brief Pain Inventory at week 12 compared to baseline. Functional interference and quality of life were secondary outcomes. We analyzed longitudinal mixed-effects models based on intent-to-treat principles. Results: Among 360 participants, mean age (SD) was 62.1 (12.7) years, 251 (69.7%) were women, and 88 (24.4%) were non-white. Compared from baseline to week 12, EA significantly reduced pain severity by 1.9 points (95% Confidence Interval 1.5-2.3, p < 0.001), and AA significantly reduced pain severity by 1.6 points (1.1-2.0, p < 0.001). AA was non-inferior to EA at reducing pain severity (p = 0.04). Both EA and AA also significantly improved functional interference (both p < 0.001), physical health (both p < 0.001), and mental health (p = 0.003, p < 0.001) compared to UC. Adverse events (AEs) were mild in both groups; however, 16 (11.2%) in AA stopped treatment due to AEs (mostly ear discomfort) as compared to 1 in EA (0.7%), p = 0.001. Conclusions: Among cancer survivors with chronic musculoskeletal pain, both EA and AA effectively reduced pain and improved quality of life. AA was non-inferior to EA at reducing pain but associated with higher discontinuation rates. These results will guide implementation of acupuncture in oncology care to address the unmet pain management needs of cancer survivors in the era of the opioid epidemic. Clinical trial information: NCT02979574 .