Acupuncture for Managing Chronic Musculoskeletal Pain in Cancer Survivors: Jun Mao, MD, MSCE

Jun Mao, MD, MSCE.

Nearly 50% of cancer survivors are undertreated for chronic pain, a condition which negatively impacts cancer-related outcomes, physical function, and quality of life. Due to the challenges of the opioid crisis, non-pharmacologic alternatives for pain management in cancer survivors are greatly needed. In the randomized PEACE trial, results of which were recently published in JAMA Oncology, investigators found that patients receiving electroacupuncture and auricular acupuncture experienced significant pain reduction compared with those receiving standard pain management, including analgesic medications, physical therapy, and glucocorticoid injections. In this interview with Oncology Data Advisor, Dr. Jun Mao, Chief of the Integrative Medicine Service at Memorial Sloan Kettering Cancer Center and lead author of the study, discusses the significance of this finding and shares the benefits of different acupuncture techniques for reducing chronic musculoskeletal pain in cancer survivors.

What are some of the most challenging aspects of managing chronic musculoskeletal pain in cancer survivors?

Jun Mao, MD, MSCE: Cancer survivors are more likely to experience chronic pain due to prior surgery, chemotherapy, and hormonal treatment. Many pain medications cannot be used safely in cancer survivors due to their adverse effects on kidney, liver, cardiac, or gastrointestinal systems. Because of the opioid epidemic in the United States, doctors are hesitant to prescribe opioids, and survivors are very hesitant to take them for pain management. Therefore, we need effective non-pharmacological interventions to manage pain in this population.

What prompted you to investigate the use of electroacupuncture and auricular acupuncture to reduce chronic musculoskeletal pain in cancer survivors?

Dr. Mao: There is robust evidence favoring electroacupuncture for managing pain in the population of individuals without cancer. However, a patient needs to go to a licensed acupuncturist or a physician with special training in acupuncture. Although acupuncture is increasingly available in academic cancer centers, it may be difficult to find acupuncturists in community or rural settings. The auricular acupuncture treatment used in this trial, called Battlefield Acupuncture, is a standardized procedure that can be learned in a matter of a day. The Veteran Health Administration has trained thousands of physicians to use it for managing pain. Auricular acupuncture has clear short-term benefit based on clinical experience; however, its long-term effectiveness has never been studied. Therefore, we wanted to study the effectiveness of these different techniques to inform appropriate use of acupuncture for managing musculoskeletal pain in cancer survivors.

What was the significance of your findings?

Dr. Mao: We found that both acupuncture techniques effectively reduced pain and improved quality of life compared with usual medical care. The patients in the acupuncture groups also experienced reduced pain medication use. In addition, we found that the effects of the acupuncture were persistent for over three months beyond the last treatment. However, auricular acupuncture was not as effective as electropuncture and had more side effects. About one in 10 patients treated with auricular acupuncture reported ear pain that prevented them from receiving more treatments.

How do you think that your results should impact current clinical practice?

Dr. Mao: Physicians should consider referring their cancer survivors with musculoskeletal pain to receive acupuncture as comprehensive pain management. If there is no availability for regular acupuncture, physicians can learn auricular acupuncture to help their patients. I also hope the results of this study will lead to more insurance coverage for the use of acupuncture for chronic musculoskeletal pain in cancer survivors so that individuals from underserved communities can have access to acupuncture, as well.

About Dr. Mao

Jun Mao, MD, MSCE, is Chief of the Integrative Medicine Service and Laurance S. Rockefeller Chair in Integrative Medicine at Memorial Sloan Kettering Cancer Center. He was also the immediate past President of the Society of Integrative Oncology. Dr. Mao specializes in using holistic treatment plans and evidence-based complementary therapies in tandem with conventional treatments to improve the quality of life of cancer patients and survivors. His research focuses on studying the mechanisms and benefits of integrative health therapies, including acupuncture, massage, herbs, yoga, and tai chi for managing treatment-related symptoms and improving wellness.

For More Information

Mao JJ, Liou KT, Baser RE, et al (2021). Effectiveness of electroacupuncture or auricular acupuncture vs usual care for chronic musculoskeletal pain among cancer survivors: the PEACE randomized clinical trial. JAMA Oncol. [Epub ahead of print] DOI:10.1001/jamaoncol.2021.0310

Transcript edited for clarity. Any views expressed above the speaker’s own and do not necessarily reflect those of Oncology Data Advisor. 


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