​Mother Rong + Yang Yongxin = relieve cancer pain?

*For medical professionals to read and refer to JAMA Oncology: Acupuncture has been proven to relieve cancer pain.
Acupuncture has been proven to relieve the pain of the ancestor Rong Yongxin and the king of thunder and lightning.
How can the pain be relieved if you listen to it? ! Not to mention, the recent PEACE study found that electric acupuncture can really bring painless peace to cancer survivors.
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This article summarizes pain: it may be as difficult as cancer.
Research: electric acupuncture and ear acupuncture work well.
Acupuncture: not just Guidelines for alleviating chronic pain: taking into account the evidence and the wishes of the patient 1 Pain: may be as difficult as cancer.
Cancer is terrible, but cancer-related pain is just as difficult [1]
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Approximately 64% of patients with advanced or metastatic cancer suffer from pain, and 59% of patients undergoing cancer treatment will tell their doctors about their pain
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Even after the treatment has been completed, one-third of patients feel cancer-related pain lingering
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Although opioids can control pain well, the pain of cancer patients is still not well controlled in areas where opioids are in sufficient supply
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Figure 1.
1 Stepwise analgesia recommended by WHO The presence and severity of pain have a major impact on the survival and health-related quality of life of patients
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Even if ordinary people have stomach pains and diarrhea occasionally, life is not so easy, not to mention cancer patients need to bear the pain silently for years
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Poor pain control can also make the patient's psychological condition worse and reduce social support
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In the face of a doctor who never makes him "not in pain", the patient will probably not be too satisfied.
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Figure 1.
2 A recent study published on JAMA Oncology has no significant difference in the pain burden of various cancer patients.
Effective control of pain is All patients need
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In order to better care for cancer patients, clinicians should know how to control pain
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In addition to drug analgesia, other auxiliary methods are also worth trying.
For example, a recent study published on JAMA Oncology [2] evaluated the value of electroacupuncture and ears for relieving chronic muscle pain in cancer survivors
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 2 Study: Electro-acupuncture and ear acupuncture work well.
This study from Memorial Sloan-Kettering Cancer Center included 360 cancer survivors who had chronic musculoskeletal pain for at least 3 months
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The average age of these participants was 62.
1 years and 69.
7% were women
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The study used the Brief Pain Inventory (BPI) score to assess the degree of pain in the patients.
At the beginning of the study, the average score of the participants in the Brief Pain Inventory (BPI) was 5.
2 points
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  Figure 2.
1 360 participants were divided into three groups.
Participants were randomly assigned to the electroacupuncture group (145 people), the ear acupuncture group (143 people) or the conventional treatment group (72 people) according to the ratio of 2:2:1
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The intervention group received electric acupuncture or ear acupuncture 10 times a week
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Participants in the electro-acupuncture group were treated by an acupuncturist and selected 4 acupuncture points near the painful area, and at least 4 additional acupuncture points in other body parts to resolve coexisting symptoms
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Participants in the auricular acupuncture group received auricular acupuncture treatment according to a fixed plan, and the needles were kept on the ears for 3 to 4 days
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From the 12th week to the 24th week of the study, the routine care group received 10 acupuncture treatments
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 Figure 2.
2 The position of the ear acupuncture needles In the 12th week of the study, a total of 340 participants completed the study
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Compared with conventional care, the pain severity of participants in the electroacupuncture group was reduced by 1.
9 points (97.
5% CI 1.
4-2.
4 points; P <0.
001), and the pain of participants in the ear acupuncture group was reduced by 1.
6 points (97.
5% CI 1.
0- 2.
1 points; P <0.
001), but the study did not find evidence that ear acupuncture is not worse than electric acupuncture
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At the same time, compared with the conventional nursing group, both electric acupuncture and ear acupuncture improved pain-related dysfunction and improved the patient's physical and mental life quality
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Compared with the conventional care group, the use of analgesics in the electroacupuncture and ear acupuncture groups decreased at the 12th week, and it continued until the 24th week
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 Regarding the safety of acupuncture treatment, the treatment-related adverse events found in the study were minor
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Of the 143 patients who received ear acupuncture treatment, 15 (10.
5%) discontinued treatment due to adverse events, while 1 of 145 patients who received electroacupuncture treatment (0.
7%) discontinued treatment due to adverse events.
The tolerance of electroacupuncture is relatively better (P <0.
001)
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 Figure 2.
3 Electric acupuncture and ear acupuncture can alleviate the pain of participants.
Researchers pointed out that both electric acupuncture and ear acupuncture can effectively reduce the severity of chronic musculoskeletal pain in different groups of cancer survivors
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However, as many as 1/10 of the patients could not accept the ear discomfort caused by ear acupuncture, and the treatment was terminated
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At the same time, the study did not find evidence that ear acupuncture is comparable to electric acupuncture
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Electroacupuncture seems to be a better choice for relieving chronic musculoskeletal pain in cancer survivors, but ear acupuncture can also be tried where there is no condition for electroacupuncture
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 3 Acupuncture: Not just to relieve chronic pain Figure 3.
1 Research published in JAMA In fact, this is not the first time acupuncture and moxibustion for cancer pain has appeared in the JAMA series of journals
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As early as 2018, JAMA published a study from [3] comparing the effects of real acupuncture and fake acupuncture in relieving the joint pain caused by aromatase inhibitor treatment in breast cancer patients, and found that “real” moxibustion is talented.
There is an analgesic effect, and the "fake" moxibustion that you can find a place to play with is useless! This study from Columbia University included postmenopausal women with early-stage breast cancer who were taking aromatase inhibitors, and their BPI-WP scores were at least 3 points
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Among the participants, 110 received “real” moxibustion, 59 received “fake” moxibustion, and 57 did not receive moxibustion as a control
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Participants received acupuncture treatment twice a week for the first 6 weeks, once a week acupuncture treatment for the next 6 weeks, and another 10 acupuncture treatments in the following year
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  Figure 3.
2 The effect of "real" moxibustion is significantly better than that of "fake" moxibustion.
6 weeks after the start of the study, the average pain score of patients in the "true" moxibustion group decreased by 2.
05 points, while the "fake" moxibustion group and the control group increased by 1.
07 points respectively.
Points and 0.
99 points
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The pain degree scores of participants in the "real" moxibustion group differed by 0.
92 points (95% CI, 0.
20-1.
65) from those in the "fake" moxibustion group.
The "true" moxibustion could really relieve pain (P = 0.
01)
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However, patients in the "true" moxibustion group were more likely to have grade 1 bruises (47% vs 25%; P = .
01)
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  Figure 3.
3 System review published in JAMA Oncology The system review and meta-analysis published in JAMA Oncology in 2020 [4] summarized the current research on acupuncture and moxibustion for cancer pain relief
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This study, jointly brought by the Guangdong Provincial Hospital of Traditional Chinese Medicine and the China-Australia International Research Center of Traditional Chinese Medicine, included 17 studies into a systematic review and meta-analyzed the results of 14 studies.
It is believed that acupuncture and/or acupoint compression can reduce cancer pain and pain.
The reduction in the use of analgesics is significantly related
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  Figure 3.
4 Acupuncture and moxibustion really have analgesic effects.
The results of blinded trials show that real acupuncture can reduce the pain of cancer patients and reduce the pain of patients (average difference-1.
38 points, 95% CI, -2.
13 to -0.
64 points); Collecting data from open-label randomized clinical trials shows that the combination of acupuncture and acupuncture can also reduce pain compared with various other analgesic treatments (mean difference -1.
44 points, 95%CI -1.
98～-0.
89 points); In the study, it was also found that compared with no treatment, acupuncture and moxibustion can indeed relieve the pain of patients (average difference -1.
63 points, 95% CI -2.
14 to -1.
13 points)
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  Figure 3.
5 Acupuncture is effective for many types of cancer pain.
In addition, studies have found that the combination of acupuncture and analgesic therapy can reduce the dosage of analgesics compared with the use of analgesics alone (average difference -30.
00 mg Morphine equivalent daily dose, 95% CI -37.
5～-22.
5 mg)
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The results of the subgroup analysis show that acupuncture is effective for various types and degrees of pain, but most of the conclusions are relatively limited in research evidence
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 4 Guidelines: Taking both evidence and patient wishes into consideration.
Although the clinical trials are lively and lively, the 2021 review [5] also pointed out that there are many recommended items in the guidelines for acupuncture intervention for cancer pain, including acupuncture intervention for cancer pain and acupuncture intervention for cancer.
Postoperative pain and acupuncture intervention with aromatase inhibitors cause joint pain
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However, although the current guidelines as a whole affirm the value of acupuncture and moxibustion for relieving cancer pain, the level of evidence is not very high [6-11].
It is hoped that this situation will be improved with the continuous development of clinical trials
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 Table 1 Recommended items for acupuncture intervention in cancer pain.
A review on CA Cancer J Clin pointed out that [1], as many as 31% of cancer patients have received acupuncture treatment, but the results of current research are often contradictory.
The research focuses on various chronic pain, Various types of pain such as neuropathic pain, pain after thoracotomy, and postoperative pain are also different
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Some studies have found that acupuncture can reduce pain scores, and some studies believe that the efficacy of acupuncture and moxibustion is no different from standard treatment
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Therefore, it is recommended that clinicians discuss with each patient whether to use acupuncture and moxibustion to relieve pain, and respect the patient's personalized choice
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In fact, there is still a lack of targeted research on specific clinical pain problems.
Acupuncture and moxibustion treatment of cancer pain needs more high-quality clinical research to obtain scientific and conclusive clinical evidence to provide a basis for further clinical promotion in the future
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