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Acupuncture: a treatment for breakthrough pain in cancer?
  1. Carole A Paley1,2,3,
  2. Mark I Johnson3,4 and
  3. Michael I Bennett3,5
  1. 1Research & Effectiveness Department, Airedale NHS Foundation Trust, Steeton, Keighley, UK
  2. 2Health and Social Sciences, Leeds Metropolitan University, Leeds, UK
  3. 3Leeds Pallium Research Group, Leeds, UK
  4. 4Pain and Analgesia, Centre for Pain Research, Leeds Metropolitan University, Leeds, UK
  5. 5Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
  1. Correspondence to Carole A Paley, Research & Effectiveness Department, Ward 12 Research Office, Airedale General Hospital, Airedale NHS Foundation Trust, Skipton Road, Steeton, Keighley BD20 6TD, UK; biodynamics.physiotherapy{at}tesco.net

Abstract

Context Patients with chronic cancer pain frequently suffer severe exacerbations of pain intensity which are difficult to control adequately via pharmaceutical management. Management of these episodes of breakthrough pain (BTP) presents a challenge both to the physician and the patient, and supplemental ‘rescue’ doses of opioids required to control BTP can produce intolerable side-effects and often do not act rapidly enough to provide adequate analgesia. There is very little evidence to support the use of acupuncture for BTP in cancer and few studies have considered the rapidity of the analgesic response to acupuncture for any type of pain. However, the available physiological evidence provides a convincing rationale and one which warrants research.

Objective The objective of this paper is to debate the available physiological evidence for a rapid analgesic response to acupuncture in the context of the needs of the patient with cancer BTP, current interventions, acupuncture technique and the practical considerations involved in administering treatment rapidly and safely.

Conclusion Current evidence suggests that acupuncture has the potential to produce rapid and effective analgesia when needles are inserted deeply enough and manipulated sufficiently. For cancer BTP this represents a possible adjunctive treatment, and consideration should be given to administering acupuncture alongside ‘rescue’ doses of medication to ‘kick-start’ the analgesic response before the medication takes effect. However, research is needed to provide evidence that acupuncture is effective for BTP in cancer, and the feasibility, practicality and safety of patients administering acupuncture themselves must also be taken into account.

  • Accepted 25 August 2011.

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  • Accepted 25 August 2011.
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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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