Acupuncture for Cancer-Induced Bone Pain?

Bone pain is the most common type of pain in cancer. Bony metastases are common in advanced cancers, particularly in multiple myeloma, breast, prostate or lung cancer. Current pain-relieving strategies include the use of opioid-based analgesia, bisphosphonates and radiotherapy. Although patients experience some pain relief, these interventions may produce unacceptable side-effects which inevitably affect the quality of life. Acupuncture may represent a potentially valuable adjunct to existing strategies for pain relief and it is known to be relatively free of harmful side-effects. Although acupuncture is used in palliative care settings for all types of cancer pain the evidence-base is sparse and inconclusive and there is very little evidence to show its effectiveness in relieving cancer-induced bone pain (CIBP). The aim of this critical review is to consider the known physiological effects of acupuncture and discuss these in the context of the pathophysiology of malignant bone pain. The aim of future research should be to produce an effective protocol for treating CIBP with acupuncture based on a sound, evidence-based rationale. The physiological mechanisms presented in this review suggest that this is a realistic objective.
CIBP is a unique pain state and is characterized by central sensitization and an “up-regulated” nociceptive system. Acupuncture is known to reduce central sensitization in the dorsal horn and to reduce transmission of nociceptive information. It is likely that regular treatments reduce ongoing nociceptive transmission and sensitization and up-regulate the opioid peptide system. The release of MTPs may also help to lower central sensation. Additionally, the effect of acupuncture on the limbic system in the brain may modulate emotional responses to pain and render it more tolerable. Future research must focus upon well-designed randomized controlled clinical trials using human subjects to specifically investigate the effect of acupuncture on CIBP and focus in particular upon aspects of needle placement and dosage for optimal results. The aim of such research should be to produce an effective protocol for treating CIBP based on a sound, evidence-based rationale. The physiological mechanisms presented here suggest that this is a realistic objective.
Available at: http://www.hindawi.com/journals/ecam/2011/671043/
Carole A. Paley CA, Bennett MI, & Johnson MI. Acupuncture for Cancer-Induced Bone Pain?. Evidence-Based Complementary and Alternative Medicine. Volume 2011. doi:10.1093/ecam/neq020

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