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Cancer can be an extremely devastating diagnosis that is further distressing through the many complications that can follow whether one chooses to undergo treatment or not. One of the most common complications reported by individuals with cancer is pain; however, it is important to note that not all cancer is painful. Furthermore, the various methods of cancer treatment (with the most common being chemotherapy, surgery, and radiation) may also cause pain. Traditional mechanisms to combat cancer-associated pain have been through pharmacological agents, such as opioid analgesics.
However, alternative medicines have been making a rise in managing cancer-related pain. In 2013, it was reported that 66.5% of cancer patients have adopted complementary and alternative medicine (CAM) to manager their pain with 43.3% of those individuals being new to this form of pain management (Vinjamury et al., 2013). One of the more popular alternative methods is acupuncture. Acupuncture is a form of CAM therapy that achieves the expected outcome of relieving pain through the pricking of skin with needles.
According to Faircloth (2015), acupuncture practices originated in Asia. Thousands of years would pass before its introduction into Western’s medical practice in 1997 (although the concept was made known to the American people by way of the New York Times in 1972). Acupuncture has the ability to “successfully decrease preoperative anxiety, decrease intraoperative anesthetic requirements, assuage postoperative pain, decrease the incidence of postoperative nausea and vomiting, and support chronic pain management” (Faircloth, 2015, p.1). The use of acupuncture became more prevalent in the field of oncology in the late 1990’s after numerous complaints of pain from cancer patients even despite the use of opioids analgesics to manage this symptom (Lu, Dean-Clower, Doherty-Gilman, &Rosenthal, 2008).
The World Health Organization (WHO) suggested that pain in cancer patients be combatted with the use of around-the-clock doses of opioids which proved to be problematic in many cases. According to Vinjamury (2013) as many as 20% of these cancer patients were resistant to the analgesic effects of opioids; furthermore, long-term use of opioids had undesirable adverse effects. Some adverse effects include constipation, respiratory depressions, nausea, and endocrine dysfunction. With the need to find other means of relieving pain experienced by individuals with cancer, many scientists began to study how CAM therapies could be used for these individuals. This has resulted in a surge of research studying the effects of acupuncture and its therapeutic effects as it applies to the field of oncology in the last few decades, some of which this paper will discuss.
Literature reviewing the effects of acupuncture on cancer-related pain is relatively ambiguous. Different studies have come to different conclusions about the effectiveness of acupuncture in managing the pain of cancer patients. In one such report, seven participants underwent a 12-week case study to measure the outcome of acupuncture on cancer-related pain (Vinjamury et al., 2013). The results of this study revealed that this form of CAM therapy may possibly have a positive effect on cancer-related pain while also improving the quality of life of oncology patients. However, it should be noted that results from this study should be regarded as inconclusive due to the inadequate sample size. There has also been clinical experiments suggesting that acupuncture has the ability to relieve cancer-induced bone pain; however, results from these studies are relatively unreliable as the experiments has yet to be conducted on human subjects (Paley, Bennett & Johnson, 2011).
Results compiled from several independent studies totaling 1, 639 participants and twenty randomized control trials were analyzed “to evaluate the effectiveness and safety of acupuncture for cancer- related pain” (Hu et al., 2016). Results from this meta-analysis revealed that acupuncture therapy when used alone did not have a more favorable effect on pain management in cancer patients than did conventional drug therapy. A separate meta-analysis including five randomized controlled trials and 285 participants yielded similar results. In this study, no real evidence existed to support favorably of acupuncture over conventional drug therapy in relieving cancer-related pain (Paley, Johnson, Tashani, & Bagnall, 2015). Still most of the studies used in this analysis were found to be unreliable as there were not enough participants in either study. Evidently, there is a scarcity in objective data provided through sound clinical trials to either support or refute the undeniable effectiveness of acupuncture as a primarily beneficial tool to relieve cancer-related pain.
When tackling the task of managing cancer pain, many physicians have taken to the World Health Organization (WHO) recommended a three-step ladder to manage pain in adults. According to this ladder, the first step should be to administer non-opioid medication, such as aspirin or ibuprofen. If non-opioids do not provide relief, mild opioids (such as codeine) should be administered; followed by strong opioids (most commonly morphine) which should be increased in doses until the patient is pain-free. Drug therapy for cancer patients should be around the clock and titrated to accommodate the intensity of pain they’re experiencing.
WHO (1996) states “the effective analgesic dose of morphine varies considerably and ranges from as little as 5mg to more than 1000mg every four hours. In most patients, pain is controlled with doses 10-30mg every four hours”. For those cancer patients with insurance, the cost of prescription opioids could be free to as much as $30 monthly (with Medicare, deductibles may not exceed $360 yearly). According the Consumers Report, cancer patients who are uninsured can be looking at prescription costs anywhere from $48 upward to $247 monthly for a 30mg prescription of morphine. Comparatively, acupuncture sessions can range from $50 to $70 for cancer patients without insurance and even for those with public health insurance plans (Medicaid and Medicare) as these insurance plans do not cover CAM therapies. As CAM therapy is becoming increasingly popular in Western medicine and prescribed by providers, some private insurance companies have started to provide coverage for these forms of therapies.
Coverage can range anywhere from 10% to 100%; therefore, it is important for cancer patients prescribed acupuncture to speak with their insurance company to determine if they are covered, and if so, how much. Controversies surrounding acupuncture and the practice can be dated back to when it was first practiced in Western medicine in 1997. Much of the controversy has been on whether it is a better alternative than traditional medicine. Consumers want to be assured that the benefits of acupuncture outweigh the risks in and of itself as well as compared to traditional therapy. At this point it is important to mention that when practiced correctly, adverse effects of acupuncture is relatively minimal (MacPherson & Hammerschlag, 2012). Adverse effects of acupuncture include bruising at the site, soreness, minor bleeding or bruising, and fainting.
When deciding if this form therapy is preferential to traditional therapy, consumers must compare the adverse effects of the traditional therapy next to those of acupuncture; it would also be wise to research the effectiveness of acupuncture in treating the condition this CAM therapy is being sought for. As it relates to cancer-related pain, the only controversy surrounding acupuncture is the lingering question of whether it is truly effective or not. There is simply not enough good clinical research to objectively support the claim that acupuncture is an effective and efficient pain management technique for cancer patients. Much of the research and clinical trials that exist today have some form of bias whether it is the heterogeneity of the sample size or the small number of participants enrolled in the clinical trial.
All in all, acupuncture when used in adjunct with traditional strategies for pain relief could be a valuable pain management technique for cancer patients. There is simply not enough data to support that when used alone acupuncture is an effective pain management tool to address cancer-related pain. The World Health Organization has created a wellestablished pain management tool that uses opioid analgesics to address pain that individuals experience with cancer. However, not all individuals respond positively to traditional pain management mechanisms, which is why it is important and beneficial to include adjunct complementary and alternative therapies.
Cancer can be a world shattering and extremely distressing diagnosis, which can be even more devastating due to the numerous complications and symptoms that may follow it, especially pain. Majority of individuals diagnosed with cancer experience pain of some capacity, and according to Vinjamury (2013) as many as 20% of these individuals report that their pain is unrelieved by traditional pain management strategies, such as pharmacological drug therapy using opioids. In the most recent years, numerous physicians have been increasingly recommending CAM therapies as supplementary pain management tools to address cancer-related pain; amongst these alternative therapies is acupuncture. While acupuncture alone has not been proven to be sufficient in primarily relieving cancer pain, it appears to be a valuable addition to proven traditional, therapeutic mechanisms.
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