Acupuncture vs massage in cancer pain

Inspired by Romero et al 2022.[1]

MSKCC – Memorial Sloan Kettering Cancer Center
MA – manual acupuncture
EA – electroacupuncture
BPI – brief pain inventory
IMPACT – Integrative Medicine for Pain in Patients with Advanced Cancer Trial

key to acronyms

This is a protocol for a large-scale comparative effectiveness trial in a cancer pain population from MSKCC. The study aims to recruit 300 patients into a parallel arm study of MA plus EA versus massage in a mixed population with relatively advanced cancer (grade 3 or 4) and pain of 4 or more on a 0 to 10 scale (BPI worst pain). The trial comes with an acronym, so it is clearly well funded, or someone thinks it is really important. The acronym is IMPACT – Integrative Medicine for Pain in Patients with Advanced Cancer Trial.

As well as testing acupuncture and massage head-to-head, the study aims to evaluate the persistence of any therapeutic effects at 6 months from randomisation. A 10-week course of treatment will be followed by 4-weekly top-ups until the primary outcome (BPI worst pain in the last week) at 26 weeks.

It is nice to see the use of top-ups since this is a much better reflection of clinical practice, but I am a little curious about the timing of the last session (at 26 weeks) and the measurement of the primary outcome. When a patient is having 4-weekly acupuncture top-ups for chronic pain, the first 2 weeks are generally better than the last one of the four.

In terms of the comparison between acupuncture and massage, I would expect acupuncture to be somewhat more effective and longer lasting, but I would expect a greater preference for massage and fewer adverse events. Preference is not being measured here, but a difference in dropout rate might favour massage as an intervention in this population.

Whilst I am interested in the outcome of the trial, I do question the need to know the answer to the research question that it poses. The interventions are not mutually exclusive, indeed many of my chronic pain patients use both acupuncture and massage. I guess healthcare providers would be interested in terms of planning optimal provision to meet the needs of this population; however, in most developed countries, the provision of these interventions is likely to be suboptimal, unlike that for most pharmaceutical interventions.

References

1. Romero SAD, Emard N, Baser RE, et al. Acupuncture versus massage for pain in patients living with advanced cancer: a protocol for the IMPACT randomised clinical trial. BMJ Open 2022;12:e058281. doi:10.1136/bmjopen-2021-058281