Should physiotherapists use acupuncture for treating patients with cancer-induced bone pain? A discussion paper

BackgroundPatients suffering from pain due to bony metastases in cancer represent a challenge to the physiotherapist as part of the multidisciplinary team. Adequate pain relief improves quality of life and functional status, yet conventional analgesia often has undesirable side-effects and non-pharmacological treatments (e.g. some electrotherapies) may be contraindicated in cancer. Acupuncture is a potential treatment for cancer-induced bone pain (CIBP) as it has few side effects and is relatively easy to administer. There is a dearth of research on the use of acupuncture in treating CIBP and some practitioners express fears about treating cancer patients with acupuncture.ObjectivesTo discuss the use of acupuncture for CIBP by reviewing the physiological rationale for using acupuncture to treat CIBP and the risks and benefits of using acupuncture in clinical practice.Data SourcesEvidence was identified by searching seven major databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO, AMED and SPORTDiscus. Evidence was synthesised by the authors to raise issues and discussion points within a narrative review framework.FindingsAvailable physiological evidence supports potentially efficacious effects of acupuncture for reduction of CIBP. Clinical literature suggests that acupuncture may be effective as an adjunctive treatment for CIBP and that risks are manageable. However, there is a need for well-designed randomised controlled trials to investigate efficacy and effectiveness in patients.ConclusionsAcupuncture has the potential to provide sustained background analgesia and/or rapid onset analgesia for breakthrough pain if the appropriate points and techniques are used.