The heat of breast-cancer-related hot flashes can be effectively diminished with an ancient Chinese medical practice infused with a dash of modernity, suggests research in the August Journal of Clinical Oncology.
Electroacupuncture, in which small electric currents are applied to traditional acupuncture needles, might be more effective than gabapentin, a drug commonly used in this setting, according to a randomized controlled trial.
The trial involved 120 patients with existing complaints of treatment-related hot flashes. The women were randomized to weekly electroacupuncture, once-daily gabapentin, sham acupuncture, or placebo for 8 weeks.
A daily self-reported hot flash composite score was the primary outcome measure in the trial, which was conducted at the University of Pennsylvania in Philadelphia.
At 8 weeks, the mean reduction the hot flash score was greatest with electroacupuncture, followed by sham acupuncture, gabapentin, and placebo (–7.4 vs –5.9 vs –5.2 vs –3.4; P < .001).
Despite the fact that treatment stopped at week 8, the patients continued to record their daily hot flash experience in diaries until week 24.
At week 24, the mean reduction the hot flash score was again greatest with electroacupuncture, followed by sham acupuncture, but by this time, placebo was better than gabapentin (–8.5 vs –6.1 vs –4.6 vs –2.8; P = .002).
“These preliminary findings need to be confirmed in larger randomized controlled trials with long-term follow-up,” write the study authors, led by Jun Mao, MD, associate professor of family medicine and community health at Penn.
An expert not involved in the study was impressed by the trial design.
Dr Mao’s team “did a very good job creating adequate control conditions,” said Jennifer Ligibel, MD, director of the Leonard P. Zakim Center for Integrative Therapies at the Dana-Farber Cancer Institute in Boston.
The choice of drug treatment was also appropriate, she said. “Gabapentin is something we use widely; it is effective for hot flashes in cancer patients.”
Dr Ligibel, who has never personally undergone acupuncture, has been impressed by the treatment in her Boston clinic.
“I have had patients with symptoms for whom we tried everything and failed, and then we try acupuncture and it makes a big difference,” she said.
Acupuncture has also been found to be effective for cancer- or treatment-related nausea, neuropathy, and pain — the kind of symptoms that often linger in survivors that “we can’t do much of anything about,” Dr Ligibel explained.
Dr Mao was involved in a previous study of electroacupuncture for the relief of symptoms associated with aromatase inhibitors in breast cancer patients, which demonstrated “clinically relevant improvements” in fatigue, anxiety, and depression in women with joint pain, as reported by Medscape Medical News (Cancer. 2014;120:3744-3751).
Would regular acupuncture — without electricity — work as well for the hot flashes?
Dr Mao was noncommittal in answering. “Very little research has been done to determine whether electroacupuncture is more potent than ‘regular’ acupuncture without electric stimulation,” he said.
However, he pointed out that sham acupuncture, which consisted of needles that retracted into their handles — like a “stage dagger” — had some treatment effect. This suggests that stimulating standard body points even lightly is worthwhile, or perhaps it induces a placebo effect, he noted.
Lab science also suggests that electroacupuncture is the real deal.
“There are also a good amount of basic science experiments performed on electroacupuncture to show that it makes the brain release specific neurochemicals that are involved in pain processing and mood regulation,” said Dr Mao.
With electroacupuncture, the needles are inserted and manipulated until deqi (the sensation of soreness and tingling) is reported. “A bilateral 2 Hz current is connected between two acupuncture points using a transcutaneous electrical nerve stimulation unit,” the investigators explain. The needles are left in place for 30 minutes.