28 november 2019: Bron: JAMA

Dat acupunctuur een meerwaarde kan hebben bij het behandelen van kankerpatienten is al langer bekend, zie in gerelateerde artikelen. Nu blijkt uit een meta-analyse van 17 gerandomiseerde studies dat acupunctuur en acupressuur de pijnklachten van kankerpatienten beduidend vermindert in vergelijking met sham behandeling (in feite een placebo want sham betekent dat er geen acupunctuur plaatsvindt met het plaastsen van de naalden). Ook was het gebruik van pijnstillers bij kankerpatienten die acupunctuur gebruikten duidelijk minder. 

Hier een grafiek uit 7 gerandomiseerde studies waarin de pijnvermindering werd vergeleken tussen een echte acupunctuur of acupressuur behandeling en een sham behandeling:

Forest Plot of the Estimated Association of Acupuncture and Acupressure With Cancer Pain Intensity

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Het volledige studierapport: Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain. A systematic review and meta-analysis is gratis in te zien. Met gedetailleerde beschrijvingen en heldere grafieken.

Hieronder het abstract van de studie plus referentielijst. 

This study found a moderate level of evidence that acupuncture and/or acupressure was significantly associated with lower pain intensity in patients with cancer compared with a sham control, which suggests a potential for a combination of acupuncture and acupressure to help reduce opioid doses in patients with cancer.

Original Investigation
December 19, 2019

Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer PainA Systematic Review and Meta-Analysis

JAMA Oncol. Published online December 19, 2019. doi:https://doi.org/10.1001/jamaoncol.2019.5233
Key Points

Question  Is the use of acupuncture and acupressure associated with improved cancer pain management compared with sham intervention and/or analgesic therapy alone?

Findings  In this systematic review of 17 randomized clinical trials and meta-analysis of 14 trials in the current English-language and Chinese-language literature, a significant association was found between real (compared with sham) acupuncture and reduced pain, and acupuncture combined with analgesic therapy was associated with decreased analgesic use. However, heterogeneity lowered the level of certainty of the evidence.

Meaning  This study found a moderate level of evidence that acupuncture and/or acupressure was significantly associated with lower pain intensity in patients with cancer compared with a sham control, which suggests a potential for a combination of acupuncture and acupressure to help reduce opioid doses in patients with cancer.

Abstract

Importance  Research into acupuncture and acupressure and their application for cancer pain has been growing, but the findings have been inconsistent.

Objective  To evaluate the existing randomized clinical trials (RCTs) for evidence of the association of acupuncture and acupressure with reduction in cancer pain.

Data Sources  Three English-language databases (PubMed, Embase, and CINAHL) and 4 Chinese-language biomedical databases (Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang) were searched for RCTs published from database inception through March 31, 2019.

Study Selection  Randomized clinical trials that compared acupuncture and acupressure with a sham control, analgesic therapy, or usual care for managing cancer pain were included.

Data Extraction and Synthesis  Data were screened and extracted independently using predesigned forms. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. Random-effects modeling was used to calculate the effect sizes of included RCTs. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach.

Main Outcomes and Measures  The primary outcome was pain intensity measured by the Brief Pain Inventory, Numerical Rating Scale, Visual Analog Scale, or Verbal Rating Scale.

Results  A total of 17 RCTs (with 1111 patients) were included in the systematic review, and data from 14 RCTs (with 920 patients) were used in the meta-analysis. Seven sham-controlled RCTs (35%) were notable for their high quality, being judged to have a low risk of bias for all of their domains, and showed that real (compared with sham) acupuncture was associated with reduced pain intensity (mean difference , −1.38 points; 95% CI, −2.13 to −0.64 points; I2 = 81%). A favorable association was also seen when acupuncture and acupressure were combined with analgesic therapy in 6 RCTs for reducing pain intensity (MD, −1.44 points; 95% CI, −1.98 to −0.89; I2 = 92%) and in 2 RCTs for reducing opioid dose (MD, −30.00 mg morphine equivalent daily dose; 95% CI, −37.5 mg to −22.5 mg). The evidence grade was moderate because of the substantial heterogeneity among studies.

Conclusions and Relevance  This systematic review and meta-analysis found that acupuncture and/or acupressure was significantly associated with reduced cancer pain and decreased use of analgesics, although the evidence level was moderate. This finding suggests that more rigorous trials are needed to identify the association of acupuncture and acupressure with specific types of cancer pain and to integrate such evidence into clinical care to reduce opioid use.

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