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Analgesic Effects of Auricular Acupuncture for Cancer Pain

2000; Elsevier BV; Volume: 19; Issue: 2 Linguagem: Inglês

10.1016/s0885-3924(99)00140-2

1873-6513

David Alimi, Carolé Rubino, Evelyne Pichard Leandri, Sabine Fermand Brulé,

Pain Mechanisms and Treatments

To the Editor: Cancer pain is a difficult problem for clinicians because analgesic drugs do not always relieve pain completely.1Portenoy R.K. Lepage P. Management of cancer pain.Lancet. 1999; 353: 1695-1700Abstract Full Text Full Text PDF PubMed Scopus (581) Google Scholar For the last 30 years, auricular acupuncture has been part of the treatment of pain.2Heping W.U. Lianyang B.I. Changsheng X.U. Petting Z.U. Analgesic effect of auriculoacupoints for postoperative pain in 102 cases.J Trad Chinese Med. 1991; 11: 22-25PubMed Google Scholar, 3Nogier P.F.M. Traité d'auriculotherapie. Maisonneuve, Moulin-lés-Metz1972Google Scholar, 4Bossy J. Bases neurologiques des réflexothérapies. Masson, Paris1975Google Scholar It has recently been used as complementary treatment of cancer pain when analgesic drugs do not suffice but this strategy needs to be evaluated. We report here the results of auricular acupuncture in a series of 20 patients with cancer pain treated between July and November 1997 in the Analgesic Unit at the Institut Gustave Roussy, a large comprehensive anticancer center in France. Twenty patients with cancer, still experiencing pain after treatment with analgesics, were included in the study. All patients had a chronic pain syndrome with peripheral or central neuropathic pain. A nurse-administered visual analogue scale (VAS) was used as a measure of the intensity of pain both before administration of the initial analgesic (initial D) and after at least 1 month of stable treatment with World Health Organization (WHO) level 2 or 3 analgesics (at D0). This stable analgesic treatment was continued after auriculotherapy. Pain intensity attaining 30 mm or more at D0 was required of all subjects. An electric chart of the ear was established for each patient by measuring the electrodermal response of the skin at the points on the ear where projected pain was suspected, based on clinical symptoms. Auricular acupuncture was then performed by inserting single-use sterile needles at points where an electrodermal response had been detected. A leaflet was given to each patient including an image of the ear where the insertion points of each needle had been marked so that the patient could report the dates when the needles fell out. This leaflet was also used to record the weekly consumption of analgesics and the pain intensity measured weekly according to the VAS. Pain intensity was evaluated by a nurse around D60 after auriculotheraphy, i.e., when patients came back to the clinic for routine follow-up of their cancer. The effectiveness of auricular acupuncture was based on the difference in pain intensity measured on the VAS at D60 and at D0, and analyzed using a t-test. Twenty patients were treated by auricular acupuncture between May and September 1997. Their average age was 54.3 with a standard deviation of 11.3. There were 19 cases of neuropathic pain: 11 cases of postmastectomy brachial plexopathy, 3 cases of postsurgical trigeminal neuropathic pain, 1 case of neuropathic lingual pain, and 1 case each of neuropathic pain associated with bladder cancer, superficial cervical plexus neuroma, diffuse pain associated with cerebellum medulloblastoma, and neuropathic spinal cord pain due to compression. In addition, there was 1 case of nociceptive pain related to a sinus neoplasm. The WHO performance status was 0 in 16 patients and 1 in the other 4. Pain appeared at the time of the diagnosis of the neoplasm in 4 patients but started after surgical treatment in the other 16 patients. The average time between treatment with the initial analgesic (initial D) and auricular acupuncture (D0) was 2.8 months, with a range of 0.7 to 4.9 months. All patients were treated with WHO level 2 analgesics and 2 patients also received morphine. At D0, the analgesic treatment has been stable for an average of 1.4 months (range 0.7–2.3 months). Initial pain, as measured on the VAS, attained 76 mm on average (standard deviation = 16). Correlation was found at D0 between pain intensity and the electrodermal response at the main auricular projection points of pain on the ear (r = 0.9, P < 0.0001). Needles used for auricular acupuncture fell out between 5 and 35 days after auricular acupuncture. There was no significant variation between initial pain and pain at D0: the average intensity at D0 was 74 mm, and the variation between initial D and D0 was an average 2 mm (standard error = 2, P = 0.16). Pain intensity decreased or remained stable after auricular acupuncture in all patients. The average pain intensity decreased by 33 mm (standard error = 5, P < 0.00001) between D0 and D60. It is noteworthy that the improvement was not limited to the diminution of the pain. Patients who experienced improvement after auricular acupuncture also said that they felt better and some felt well enough to propose interrupting their analgesic treatment. Analgesic activity provided by auricular acupuncture has been demonstrated in this study. This result, together with those of experimental studies5Oleson T.D. Kroening R.J. Bresler D.E. An experimental evaluation of auricular diagnosis the somatotopic mapping of musculoskeletal pain at ear puncture points.Pain. 1980; 8: 217-229Abstract Full Text PDF PubMed Scopus (130) Google Scholar, 6Simmons M.S. Oleson T.D. Auricular electrical stimulation and dental pain threshold.Sci Rept Anesth Prog. 1993; 40: 14-19PubMed Google Scholar and of randomized trials7Grobglas A. Traitement des lombalgies aiguës par auriculothérapie essai randomisé en double aveugle contre placebo.Semaine des Hôpitaux- Paris. 1993; 69: 639-646Google Scholar, 8Lequang T. Badaoui R. Riboulot M. Verhaeghe P. Ossart M. Analgésie postopératoire par auriculothérapie lors de la cholécystectomie par coelioscopie.Cahiers d'anesthésiologie. 1996; 44: 289-292PubMed Google Scholar encouraged us to design a randomized controlled trial with a double placebo and an independent observer, even though a negative trial has been reported.9Melzack R. Katz J. Auriculotherapy fails to relieve chronic pain a controlled crossover study.JAMA. 1984; 251: 1041-1043Crossref PubMed Scopus (30) Google Scholar The trial protocol has been written and approved by the appropriate authorities. Its main objective is to evaluate the effectiveness of auricular acupuncture in the treatment of intensive and persistent cancer pain.