Systematic Evaluation Of The Effect Of Acupuncture Therapy On Cancer Pain And A Pilot Clinical Trial

The First Part: Systematic Evaluation of the Effect ofAcupuncture Therapy on Cancer PainObjectives: To evaluate the effect of acupuncture therapy on cancer pain.Methods:Computer database searches of clinica l controlled trials: Cochrane Library(Issue 3, 2008), MEDLINE (1966-June 2008), EMBASE (1974-June 2008),PUBMED (1950-June 2008), SCIENCEDIRECT (1995-June 2008), CONTROLLEDTRIALS(1999-June 2008), Chinese S&T Period icals Database (VIP; 1989-June2008), China Academic Journal Full-text Database (CNKI; 1994-June 2008), andChinese BioMed ica l Literature Database (CBM; 1978-June 2008). Manual searches ofother releva nt literature published between January 2007 and June 2008. Two separateevaluators assessed the quality of the included literature and extracted the usefulinformation. Disa greements were resolved though discussion. Meta-analysis of theincluded literature was done with RevMan5.0, and qualitative analysis was employedwhen meta-a nalysis was not appropriate.Results:Eight published randomizedcontrolled clinica l trials (RCTs), one of high quality, with a total of 700 patients, metthe inclusion criteria. Due to flaws in design and reporting that precluded theapplica tion of meta-a nalysis, only qualitative analysis was done on the majority of thepapers. The high-quality paper showed that ear needle therapy is significa ntlysuperior to placebo in pain alleviation. The other seven (low-q uality clinica l controlledtrials with non-placebo control groups) all showed that acupuncture therapy had somepositive effect. Conclusion:Acupuncture is effective for pain relief. However, the poorquality of the majority of the papers reduces the reliability of the conclusion. Morehigh quality RCTs are needed to verify the effects.The Second Part: The Clinical StudyObjectives: To observe analgesic effect of acupuncture on carcinous pain and itseffect on the quality of patient's life and patient's mental status. Methods: 22 patients with carcinous pain were stratified into 3 levels, light, moderate and severe pain, andthen were assigned into acupuncture group and placebo group according to randomnumber table. Both groups can ma inta in the usage of analgesic drug of baseline levelduring the study period. Visua l analog scale (VAS) was employed during study periodto evaluate clinica l effect of acupuncture on pain alleviation, and QLQ-C30 scale andSCL-90 scale were used to evaluate improvement of quality of patient's life andpatient's mental status. ResultResults: No statistica lly significa nt difference was foundbetween acupuncture group and placebo group in VAS pain score measured at 7th,14th, 21st day of treatment, while within acupuncture group at the above 3 time points,no statistica lly significa nt differe nce was found in VAS score between pre- and posttreatment.Within placebo group, statistica lly significa nt difference was found in VASscore between pre- and post-treatment at 14th and 21st day (P<0.05). Result of QLQC30scale showed that no statistica lly significa nt difference was found in any otherscore factors both between the two groups and between pre- and post-treatment at 7thday of treatment within each of the two groups, with an exception of the score factorof "Loss of Appetite" between the two groups at 7th day of treatment (P<0.05). Resultof SCL-90 scale showed that no statistica lly significa nt difference was found in anyother score factors both between the two groups and between pre- and post-treatmentat 7th day of treatment within each of the two groups, with an exception of the scorefactor of "Compulsive Symptom" within acupuncture group at 7th day of treatment(P<0.05). Conclusion: Due to the limited number of study subjects, effect ofacupuncture on carcinous pain can not be determined, nor can it be proved thatacupuncture can improve patient life's quality and overa ll mental status. However,study result indica ted that acupuncture can, to some extent, improve compulsivesymptom for patients. Still, a large scale study is needed to confirm it. Considerationson the design of future large-scale randomized controlled clinica l trial: 1. Multi-centercooperation method should be employed to increase number of study subjects; 2.Observe more on the immed iate effect of acupuncture in treating carcinous pain; 3. Acombination of VAS and VRS-5 should be used for evaluation of pain.