Acupuncture

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Acupuncture

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Acupuncture is a therapeutic component of Traditional Chinese Medicine.

Common Names

  • Manual acupuncture
  • Electroacupuncture
  • Acustimulation
  • Acupressure

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For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.

What Is It

Acupuncture is a therapeutic component of Traditional Chinese Medicine. It involves the use of very thin needles along with heat, pressure, or electricity to stimulate points on the body, promoting the flow and balance of internal energy.

Acupuncture is effective in treating chronic pain and some symptoms associated with cancer treatment. Studies have shown benefit with acupuncture for postoperative pain, sleep, nausea and vomiting, dry mouth, hot flashes, peripheral neuropathy, joint pain, and other side effects caused by radiotherapy and/or chemotherapy. It may also reduce symptoms such as anxiety, depression, headache, lower back or neck pain, shortness of breath, and chronic fatigue.

Acupuncture treatments are generally safe and well tolerated by most patients, including pediatric patients and the elderly. Some conditions may require continuous treatments in order to achieve long-term effect.

How It Works

According to TCM, acupuncture points are thought to be located at specific areas along channels or meridians. Qi (pronounced chee, meaning energy) is believed to flow in this network of channels which connect different parts of the body and organs into a unified system. Pain and symptoms of disease are thought to arise when the flow of Qi is stagnated. Acupuncture treatments are used to promote the flow and balance of Qi to relieve symptoms. It is also known to release pain-relieving or feel-good chemicals in the brain.

Studies in animals and humans have shown that acupuncture can stimulate pain relief, and reduce stress, anxiety, and depression. Other studies have shown it can improve sleep, increases blood flow, and may help reduce inflammation, which may also explain pain-relieving effects.

MRI studies show that acupuncture causes changes in the brain that reflect changes in the body. Neuroimaging studies have shown that certain acupoints for dry mouth correlate to saliva production. Studies in patients with peripheral neuropathy show that acupuncture improves nerve signaling.

Researchers are continuing to examine the mechanisms by which acupuncture exerts these effects. Additional findings may help to optimize treatment regimens in the future.

Purported Uses
  • Cancer treatment symptoms
    Clinical trials support the use of acupuncture to relieve pain, nausea and vomiting, dry mouth, fatigue, hot flashes, and peripheral neuropathy resulting from cancer treatments. In some studies, benefits have been noted to last well after treatment.
  • Pain
    Clinical trials demonstrate that acupuncture can help reduce pain, including joint or nerve pain associated with cancer treatments as well as other types of chronic pain.
  • Sleep
    Several clinical trials in cancer patients and other populations show that acupuncture treatment improves sleep.
  • Fatigue
    Several clinical trials show that acupuncture reduces fatigue, including cancer-related fatigue.
  • Anxiety
    Several studies show that acupressure and acupuncture can help relieve anxiety related to tests and procedures. It may also help with anxiety in general.
  • Nausea and vomiting
    Current oncology guidelines recommend acupuncture and acupressure for chemotherapy-induced nausea and vomiting. A number of studies also support its use for postoperative nausea and vomiting and in pediatric cancer populations.
  • Constipation
    Some evidence suggests acupuncture may be helpful for constipation.
Side Effects

Acupuncture is generally safe when performed by trained practitioners. Failure to remove needles, bleeding, hematoma, dizziness, and pain have been reported. Rare instances of collapsed lung, local infections, or burns caused by moxibustion, an herbal heat application, have occurred.

Acupuncture should be avoided or additional precautions taken if:

  • You have low white blood cell count, low platelet count, or heart murmur (symptom of endocarditis): Acupuncture may increase risk of infection and bleeding.
  • You wear a pacemaker: Electrical stimulation is not advised for patients wearing electronic medical devices.
  • You have lymphedema: Patients with lymphedema should inform their practitioners before receiving treatment.
  • You are pregnant: Some acupuncture points can cause strong uterine contractions. Pregnant women should inform practitioners before seeking acupuncture treatment.
Who Can Provide this Service

Cancer patients considering acupuncture should seek certified or state-licensed practitioners who have training or experience in working with this population. Some oncology physicians may also be board-certified acupuncturists.

Where Can I Get Treatment

A majority of National Cancer Institute (NCI)-designated cancer centers offer acupuncture as part of supportive care. Clinical trials at MSK are underway to evaluate acupuncture in patients with advanced cancers, cognitive difficulties, and for chronic pain.

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For Healthcare Professionals

Clinical Summary

Acupuncture is an integral component of Traditional Chinese Medicine (TCM) that originated more than 2,000 years ago. Treatment involves stimulation of one or more predetermined points on the body along with needles, heat (moxibustion), pressure (acupressure), or electricity (electroacupuncture) for therapeutic effect. Acupuncture has been evaluated in cancer patients for control of various symptoms including pain, neurological side effects, fatigue, insomnia, and nausea. It is also recommended across various oncology supportive care guidelines (108) (133).

Data show that acupuncture is useful for cancer pain management (106) (107). A recent meta-analysis found that acupuncture and/or acupressure was significantly associated with reduced cancer pain and decreased use of analgesics (116). In patients undergoing autologous hematopoietic stem cell transplantation, acupuncture prevented escalation of nausea, lack of appetite, and drowsiness, and also significantly reduced pain medication use (103) (134). In head and neck cancer patients, acupuncture improved xerostomia following radiotherapy (36) (43) (44) (63) (70), with significant reductions in frequency and severity of symptoms versus standard care (136). In lung cancer patients, acupuncture may improve fatigue (109), pain, and well-being (76). And larger trials show that acupuncture reduces chronic musculoskeletal pain in patients with various cancers (132) and fatigue in breast cancer patients (71).

Several studies also demonstrate benefit with acupuncture for persistent joint and nerve pain. In breast cancer patients, acupuncture alleviated aromatase inhibitor-induced joint pain (110) and stiffness, and improved physical well-being (46) (74) and quality of life (96). Electroacupuncture significantly improved fatigue, anxiety, and depression as well as arthralgia compared with usual care (86) (87). In patients receiving neurotoxic chemotherapies, acupuncture improved peripheral neuropathy and other symptoms in addition to pain (18) (19) (80) (115) (124) (130) (135) with long-term improvements observed post treatment (125). Benefits with acupuncture have also been observed for peripheral neuropathy associated with diabetes and AIDS (15) (16) (17).

Several studies on acupuncture for sleep disorders demonstrate clinically relevant improvements in insomnia (112) (122) and lasting effects post-therapy (123). Similar improvements were observed in cancer patients (111), including a trial that compared acupuncture with the gold standard for insomnia treatment, cognitive behavioral therapy for insomnia (CBT-I) (121). Secondary analyses from this study indicate that those with clinically meaningful improvements in insomnia also had improved cognitive function (129).

For hot flashes, acupuncture was as effective as standard care in breast cancer patients (45), and early phase studies also suggest it may relieve hot flashes in prostate cancer patients (64) (65) (66). In addition, electroacupuncture was more effective than gabapentin with fewer side effects (82), and comparable to gabapentin for improving sleep quality (98).

Acupuncture has long shown benefit for treatment-related nausea and vomiting (38) (39) (41) (81) (91) (92) (93). Studies on whether acupuncture can reduce lymphedema are mixed (113) (114). Acupuncture did not reduce postoperative ileus from standard surgery (40) (56), but electroacupuncture did reduce postoperative ileus and analgesic use after laparoscopic surgery for colorectal cancer (73).

In palliative cancer care, acupuncture is being evaluated as an intervention to reduce cachexia and unintentional weight loss (88) (89), and a pilot study found auricular acupuncture safe and feasible to increase appetite and weight gain versus usual care (131). Other studies have found various forms of acupuncture can help alleviate pain (35) (36) (67), and a meta-analysis determined this effect is more than just placebo (126).

Acupuncture is generally safe, well tolerated (47) (48) (49) (68) (69), and cost-effective (9) (33) (34). Some conditions require continuous treatments in order to achieve long-term effect. Animal studies suggest caffeine can inhibit the pain relieving effect of acupuncture (102). Pregnant women, patients with lymphedema, those wearing pacemakers, and those with low platelet count should inform their practitioners before receiving treatment.

Cancer patients considering acupuncture should seek certified or state-licensed practitioners who have training or experience in working with cancer patients. Some oncology physicians may also be board-certified acupuncturists. Clinical trials at MSK are underway to evaluate acupuncture in patients with advanced cancers, cognitive difficulties, and for chronic pain.

Purported Uses
  • Cancer treatment symptoms
  • Pain
  • Neuropathy
  • Fatigue
  • Sleep
  • Anxiety
  • Nausea, vomiting
  • Constipation
Mechanism of Action

According to TCM, acupuncture points are thought to be located at specific areas along channels or meridians. Qi (pronounced chee, meaning energy) is believed to flow in this network of channels which connect different parts of the body and organs into a unified system. Pain and symptoms of disease are thought to arise when the flow of Qi is stagnated. Acupuncture treatments are used to promote the flow of Qi to relieve symptoms. It is also known to stimulate release of endogenous opioids.

Animal studies suggest acupuncture induces analgesia through different opioid receptors under varying conditions (53), but that effect was blocked by naloxone, an opioid antagonist (50) (51). Further, mice lacking opiate receptors showed low analgesic effect following electroacupuncture (EA) (52). Acupuncture also increases neuropeptide Y suggesting it may help to reduce stress and depression (59) (60). Acupuncture protects against cerebral ischemia by increasing blood flow to the ischemic brain region via neural regulation (55). The systemic anti-inflammatory activities of EA are thought to be modulated by dopamine (79).

In patients with fibromyalgia, analgesic effects of acupuncture are attributed to increased mu-Opioid receptor binding potential (127). In patients with peripheral neuropathy, acupuncture improves nerve conduction (14). Needling of LI-2, one of several acupoints used to treat xerostomia, was associated with neuroimaging changes correlated to saliva production (58). Other studies using functional magnetic resonance imaging (fMRI) also show that acupuncture elicits brain changes that correlate with neurological effects produced (57). A meta-analysis of fMRI research confirmed that acupuncture modulates a variety of brain activity including somatosensory, affective, and cognitive processing (127).

Long-term benefits seen with EA and to a lesser extent sham-EA post-treatment for hot flashes among breast cancer survivors suggest that both interventions produce underlying physiologic changes not induced by gabapentin (82). That sham-EA demonstrated greater effects with reduced nocebo effects than pill-placebo (82) also may explain why some acupuncture trials find similar efficacy between active and sham interventions. Other data indicate that higher baseline expectancy predicts treatment response with sham-EA but not EA, suggesting divergent mechanisms and that patients with low expectancy may do better with EA than sham (94).

Several studies have also evaluated other moderators in an effort to determine who may benefit more from acupuncture. In an exploratory study, women who were carriers of at least 1 of 6 genotypes (ADORA1 rs41264025-GA or rs16851029-GG or rs12744240-GT, COMT rs6269-GA, TCL1A rs2369049-GG, and TRPV1 rs8065080-TT) were significantly more likely to respond to acupuncture for hot flashes than noncarriers (137). In a meta-analyses of high-quality acupuncture trials for chronic pain, among five patient characteristics evaluated – age, sex, pain duration, pain severity, and psychological distress – only baseline pain severity potentially moderated acupuncture treatment effects (138).

Contraindications
  • Neutropenia, thrombocytopenia, or history of endocarditis
    Acupuncture may increase risk of infection and bleeding. Use with caution.
  • Pregnancy
    Pregnant women should inform practitioners before seeking acupuncture treatment.
  • Pacemakers
    Electrical stimulation is contraindicated for patients wearing electronic medical devices.
Adverse Reactions

Acupuncture is generally safe when performed by trained practitioners. Failure to remove needles, bleeding, hematoma, dizziness, and pain have been reported. Pneumothorax, local infections, and burns caused by moxibustion, an herbal heat application, are rare (49) (68) (69).

Practitioners and Treatments

Cancer patients considering acupuncture should seek certified or state-licensed practitioners who have training or experience in working with this population. Some oncology physicians may also be board-certified acupuncturists.

A majority of National Cancer Institute (NCI)-designated cancer centers offer acupuncture as part of supportive care. Clinical trials at MSK are underway to evaluate acupuncture in patients with advanced cancers, cognitive difficulties, and for chronic pain.

Dosage (OneMSK Only)
References
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