Acupuncture and acupressure for cancer patients

ALSO KNOWN AS: Traditional Chinese medicine (TCM), complementary and alternative medicine (CAM), Oriental medicine (OM)

DEFINITION: Acupuncture is a technique in which hair-thin, sterile, disposable needles of varying lengths are inserted into the skin and muscles at specific anatomical points (called "acupoints") in order to treat ailments, including pain and certain diseases. It is one branch of traditional Chinese medicine (TCM) that originated in China around four thousand years ago to prevent, diagnose, and treat diseases in both humans and animals.

Acupressure is a variation of acupuncture in which therapists or patients press on acupoints with their fingers instead of inserting needles. Only specifically trained, licensed professionals can treat patients using acupuncture needles, but patients can be taught (preferably by a licensed professional) to perform acupressure on themselves. In 1996, the Food and Drug Administration (FDA) approved the acupuncture needle as a medical device. In 1997, the National Institutes of Health (NIH) began evaluating the safety and effectiveness of acupuncture as a complementary and alternative medicine (CAM) treatment. According to TCM principles, twelve major meridians are theorized to course invisibly along the body surface, including six paired and two unpaired channels. These meridians correspond to and connect with certain internal organs and physiological systems as understood in both traditional Chinese and Western medicine. Every acupoint is named and numbered according to its location on a specific meridian (for example, P6 or pericardium 6). The year 2021 marked fifty years since acupuncture was introduced as a treatment to the U.S. public. Acupuncture treatments have become an industry totaling approximately $4 billion. Acupuncture became a regulated treatment in 47 states and a practice covered by insurance companies.

Upon needling, the acupuncturist attempts to unblock, move, or alter what TCM refers to as the qi or chi (pronounced “chee”) of the body. This qi is a vital force that is thought to flow along the meridians and throughout the body and organ systems. TCM posits that qi is formed from a merging of yin and yang, which are opposite energy states that permeate the universe. An imbalance of yin and yang in the body is thought to lead to a disruption of qi, leading to disharmony in physical and psychic well-being and thus to certain ailments or diseases. The acupuncturist (or acupressure practitioner) tries to restore a healthier balance of yin and yang in the patient. Many Western and Eastern acupuncturists blend TCM theory with modern understanding of neuroanatomy and the immune and other physiological systems.

Cancers diagnosed or treated: In Western cancer management, acupuncture and acupressure are primarily used to mitigate the side effects related to conventional cancer treatments such as chemotherapy, radiation treatment, and surgery, or side effects of the disease itself. These side effects include chemotherapy-related nausea and vomiting, dyspnea (shortness of breath in advanced cancer cases), pain (either from a conventional treatment or the cancer itself), fatigue, depression, vasomotor symptoms (hot flashes), and treatment- or cancer-related immunosuppression. In most instances, acupuncture or acupressure interventions are used in addition to pharmaceutical treatments, such as therapy (such as Odansetron) for nausea and vomiting.

Why performed: Cancer patients and their clinicians often resort to acupuncture and acupressure (and other alternative medical treatment modalities) for symptoms that are not amenable or responsive to traditional therapies. Sometimes they are used to augment the effectiveness of conventional medicines, as in the case of antiemetic therapies for nausea and vomiting, which can lead to weight loss and depression.

Some patients (and their clinicians) are seeking a more holistic approach to healing, viewing acupuncture and acupressure as methods that restore harmony to the body, treating the whole person instead of just the disease. Often patients take solace in the “mysterious” mechanisms underlying alternative treatments. Many acupuncturists are intrigued by the TCM philosophies and theories, at the same time applying current Western knowledge of anatomy and neurophysiology to their techniques. Most acupoints correspond to specific nerve pathways or receptors and/or highly vascular areas. There is strong evidence that acupuncture modulates neurotransmitters, leading to the release of endogenous opioids (endorphins and enkephalins) for analgesia (pain relief). Manipulation of certain acupoints stimulates the autonomic nervous system, leading to changes in blood circulation and engaging components of the immune and systems (proteins called "cytokines" or the release of endogenous corticosteroids and other hormones). These procedures can also alter blood pressure, heart rhythms, and body temperature. Not all the mechanisms involved in successful acupuncture and acupressure treatment are understood, and they remain a subject of scientific investigation. Some skeptics believe that they work primarily via the placebo effect.

Patient preparation: Very little patient preparation is required for these procedures. The patient disrobes to the extent required for examination and the placement of acupuncture needles or accessibility to acupressure points. Some acupuncturists will take a patient’s medical history and ask questions about diet and exercise. Some will also look at the patient’s tongue and feel his or her pulse in order to make a TCM diagnosis and appropriate acupoint prescription tailored to the patient’s needs. A more Westernized approach would be to apply a standard point prescription for a particular malady, omitting such TCM elements as tongue and pulse exams.

Steps of the procedure: The acupuncturist will feel for the appropriate acupoints, often massaging the area prior to needle insertion. The skin is then cleaned with an alcohol wipe and the needle is inserted until the practitioner feels some resistance and/or the patient feels a tingling or cramping sensation. This is referred to as “obtaining the qi,” or De Qi. Many practitioners then manipulate the needle, using hand technique (shou fa) to move, supplement, or drain the qi and/or yin and yang. The needles are then usually left in place for ten to twenty minutes.

In acupressure, the patient or practitioner applies pressure to the acupoints for a few minutes, repeating this action at intermittent intervals over a specified period of time. Sometimes a band with an attached stud is applied over an acupoint and the patient is instructed to press the stud into the point at prescribed intervals in an effort to obtain a De Qi response during point stimulation.

Sometimes an acupuncturist will apply a small electric current to the needles in a technique called "electroacupuncture." This is another method of stimulating the acupoints. Various other methods of stimulation are employed as well. Moxibustion applies heat to the acupoints using burning the herb mugwort (Artemisia vulgaris) or wormwood (Artemisia absinthium). The American Cancer Society reported in 2011 that this method has not been proven to be beneficial for cancer prevention or treatment, however. Aquapuncture is a technique in which acupoints are injected with drugs, vitamins, flower essences, herbal extracts, or other fluids for longer-term stimulation of acupoints.

After the procedure: A properly treated patient should experience relaxation, deeper respiration, and increased vitality following acupuncture, since energetic balance has supposedly been restored. For treatment of specific cancer-related symptoms, some immediate relief is expected, followed by delayed improvement, especially after multiple acupuncture or acupressure sessions.

Risks: Acupuncture should be avoided in patients with thromobocytopenia or aplasia or in those treated with anticoagulants. Some common side effects are bruising, local bleeding, and mild pain in the treated areas. The risk of infection is small if sterile, disposable needles are used. There is a very small risk that the lungs or other internal organs can be punctured if a needle is placed too deep.

Results: The results of many random, controlled clinical trials have demonstrated that acupuncture is effective for reducing episodes of acute vomiting following for breast and other cancers. The same and other studies have shown that acupressure at certain acupoints is effective for reducing episodes of acute nausea following chemotherapy. Both acupuncture and acupressure have been more effective for prophylactic treatment of vomiting and nausea following conventional cancer treatment rather than stopping these symptoms once they have started. One study indicated that the effectiveness of acupuncture for reducing vomiting episodes following chemotherapy was increased for up to twenty-four hours when acupressure followed needling therapy.

A 2003 randomized, controlled trial of acupuncture for the relief of cancer-related pain found that ear acupuncture (stimulation of acupoints corresponding to different body areas on the ear) was effective for reducing the intensity of cancer-related pain. Other clinical trials have shown that acupuncture may help reduce the number of hot flashes in men being treated with hormones or surgery for prostate cancer and women being treated with tamoxifen or related hormone therapies for breast cancer, and may mitigate several other treatment side effects, including dry mouth, depression, and weight loss, as noted by the National Cancer Institute in 2013. Investigators, however, have noted a dearth of random, double-blind, controlled clinical trials for substantively proving the effectiveness of these alternative therapies. The development of a sham acupuncture needle (the needle withdraws into the shaft upon “insertion” at true acupoints or the tip is blunted) may improve the rigorousness of these trials, particularly if the acupuncturist can also be blinded to the treatment group and not transmit lack of confidence to the control-group patient.

In 2024, researchers published a report on the positive effects of acupuncture in bringing relief to patients with Cancer-related insomnia (CRI). This sleep disorder results in many negative symptoms, such as stress, anxiety, and an overall reduced quality of life. A range of sedatives can assist in providing relief; however, several of these can result in negative side effects such as cognitive impairments. The study demonstrated the effectiveness of different types of acupuncture for CRI without the negative impacts of medication. Besides acupuncture, other forms include electroacupuncture.

Bibliography

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