Acupuncture in cancer study reignites debate in Nature

Acupuncture is widely used by cancer patients, not least in the US, where the backlash against opioid pain killers is strongest. Some of the indications are supported by good evidence, for example nausea and vomiting from chemotherapy; in others the evidence is weaker, but acupuncture may still be as good an option as anything else, and it has minimal side effects. Recent US research has bolstered the evidence for acupuncture’s effectiveness in reducing the pain caused by hormone therapy for breast cancer. This was a fair-sized (226 women), six-week trial of acupuncture vs sham acupuncture at 11 different cancer centres. Almost twice as many in the acupuncture group achieved a clinically meaningful improvement in pain scores, and it persisted after the treatment course was finished. The results were presented at a breast cancer conference and then made it into a commentary article in the prestigious journal ‘Nature’: This would appear to be all good news but a few acupuncture sceptics posted their usual complaint: it’s just a ‘theatrical placebo’. On this occasion there has been an impressive pro-acupuncture response from biomedical experts in the field. Their main points were these:

  • Acupuncture for pain relief has a sound basis in neuroscience
  • This trial was better blinded and provides stronger supporting evidence than exists for the usual non-drug treatments used in palliative care, such as cognitive behavioural therapy (CBT) or exercise. For sceptics to reject acupuncture trial results because of inadequate blinding, but accept these other therapies, indicates an inherent bias..
  • Acupuncture can be good for patients, without the potentially serious side effects of potent drugs, so it’s worth considering even if the underlying mechanisms are unclear.

In the UK, NICE was persuaded in 2016 to continue to allow complementary and alternative therapies (including acupuncture) as treatment options in supportive and palliative care (as set out originally in its 2004 guideline: Research such as that described above should strengthen the case for the NHS to improve what is currently a patchy and largely inadequate acupuncture offering.

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