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ORIGINAL ARTICLE
Year : 2018  |  Volume : 14  |  Issue : 1  |  Page : 99-102

Clinical analysis of electroacupuncture and multiple acupoint stimulation in relieving cancer pain in patients with advanced hepatocellular carcinoma


1 Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University, Luzhou, PR China
2 Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, PR China

Date of Web Publication8-Mar-2018

Correspondence Address:
Dr. Lili Xu
Department of Rehabilitation, The Affiliated Hospital of Southwest Medicine University, Luzhou 646000
PR China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_736_17

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 > Abstract 

Objective: The objective of this study is to investigate the clinical efficacy and safety of electroacupuncture and multiple acupoint stimulation in relieving cancer pain in patients with advanced hepatocellular carcinoma.
Methods: Sixty-five cases of advanced hepatocellular carcinoma with cancer pain were selected in our hospital and were divided into electroacupuncture multiple acupoint stimulation group (electroacupuncture group) (n = 32) and fentanyl transdermal patch analgesia group (control group) (n = 33) according to analgesic methods and intentions. In the electroacupuncture group, electric acupuncture treatment was administered at different acupoints, including Baihui, Quchi, Neiguan, Xuehai, Zusanli, and Sanyinjiao acupoint, once a day for 7 days. In the control group, a fentanyl transdermal patch was placed on the upper left arm every 3 days and replaced with a continuous external paste once for 7 days. Pain scores in the two groups before and during the treatment were evaluated with a visual analog scale (VAS), and adverse reactions during the treatment were recorded.
Results: The VAS pain score of the electroacupuncture group was significantly decreased on day 3 (P < 0.05), but the pain scores were not significantly different (P > 0.05) between the two groups 4 days after treatment. For treatment-related side effects, there were 3 cases of subcutaneous hemorrhage in the electroacupuncture group; 1 case of skin rashes and 3 cases of nausea and vomiting in the control group. The incidences of adverse reactions in the two groups were 9.4% and 12.1%, respectively, without significant difference (P > 0.05).
Conclusion: Cancer pain in patients with advanced hepatocellular carcinoma can be alleviated with electroacupuncture and multiple acupoint stimulation, but the onset pain relief was slow. To improve the analgesic effects of this technique, the combination of various analgesic methods should be necessary in early stage of the treatment.

Keywords: Cancerous pain, electroacupuncture, hepatocellular carcinoma, multiple acupoint stimulation, pain relief


How to cite this article:
Xu L, Wan Y, Huang J, Xu F. Clinical analysis of electroacupuncture and multiple acupoint stimulation in relieving cancer pain in patients with advanced hepatocellular carcinoma. J Can Res Ther 2018;14:99-102

How to cite this URL:
Xu L, Wan Y, Huang J, Xu F. Clinical analysis of electroacupuncture and multiple acupoint stimulation in relieving cancer pain in patients with advanced hepatocellular carcinoma. J Can Res Ther [serial online] 2018 [cited 2019 Oct 17];14:99-102. Available from: http://www.cancerjournal.net/text.asp?2018/14/1/99/226757


 > Introduction Top


In patients with advanced hepatocellular carcinoma, continuous tumor enlargement frequently leads to persistent and severe pain symptoms. Pain in the liver was a common symptom of liver cancer in late stages, and the pain incidence rate exceeded 50%.[1] The nature and characteristics of pain in this region have also differed according to the locations of liver cancer lesions. Pain has generally initiated in the right ministry or subxyphoid, and the nature of pain was primarily intermittent or the durative aches. Before pain was induced, patients can feel discomfort in the upper right abdomen, and pain was mainly attributed to rapid tumor enlargement, liver envelope compression, and traction force. Pain could also be triggered by the stimulation of liver envelope from tumor necrosis.[2] In serious cancer pain, morphine and other major analgesics have been commonly administrated for clinical treatments, and their effects were accurate, while with high incidence of side effects, such as nausea, vomiting, constipation, and other conditions. In traditional Chinese medicine therapy, acupuncture was an important component with a unique curative effect against chronic pain.[3],[4] Acupuncture also alleviated pain in cancer without inducing side effects. This study investigated the clinical efficacy and safety of electroacupuncture and multiple acupoint stimulation in the treatment of cancer pain in patients with advanced hepatocellular carcinoma.


 > Methods Top


Patients

Sixty-five cases of advanced hepatocellular carcinoma with cancer pain were selected in our hospital, and they were divided into electroacupuncture multiple acupoint stimulation group (electroacupuncture group: n = 32) and fentanyl transdermal patch analgesia group (control group: n = 33) according to analgesic methods and intentions. In the electroacupuncture group, 20 were males and 12 were females, and their average age was 58.6 ± 12.3 years. In the control group, 22 were males and 11 were females, with an average age of 60.3 ± 11.8 years. The following inclusion criteria were considered: (1) hepatocellular carcinoma diagnosis, such as clinical or pathological diagnosis, was clear; (2) patients yielded visual analog scale (VAS) score of 4–8 points for cancer pain; (3) patients were in clinical Stage IV corresponding to distant metastasis; (4) patients signed an informed consent; and (5) this study was approved by the medical ethics committee of our hospital. The following exclusion criteria were: (1) liver cancer diagnosis was unclear; (2) patients' VAS scores for cancer pain were 0–3 or 9–10; (3) patients suffered from multiple brain metastases; (4) patients previously received electroacupuncture therapy; and (5) patients presented with allergic reactions to fentanyl.

Electroacupuncture and multiple acupoint stimulation

Baihui, Quchi, Neiguan, blood, Zusanli, and Sanyinjiao were selected as acupuncture acupoints. After an acupoint was selected and routine disinfection was performed, the acupoint was manually manipulated with a needle for 1 min using 20 mm × 40 mm of a Huatuo sterile acupuncture needle to stab into a gas. Quchi and Neiguan in the upper limbs and Zusanli and blood in the lower limbs were selected, and acupoints were continuously stimulated with a G6850-type electric needle instrument with a 2 Hz continuous wave for 20 min. The intensity of a patient's tolerance was determined once a day, and the treatment was lasted for 7 days.

Fentanyl transdermal patch analgesia

The skin was cleaned and dried, and a fentanyl transdermal patch was affixed to the flat area of the left upper arm without hair and to ensure that the film was flat then slightly pressed. In this manner, the patch could come in full contact with the skin. Once the paste was replaced, the exchange position should be determined, and fentanyl accumulation should be avoided. Fentanyl was replaced once every 3 days.

Pain score determination

On a piece of paper, a 10 cm horizontal line was drawn, “0” was labeled on one side indicating painless and “10” was labeled on the other end corresponding to painful. The patient was allowed to mark on the line according to their sense of self to indicate the degree of pain: 0 point, painless; 1–3 points, with slight pain that could be endured by the patients; 4–6 points, pain that could affect the patients' sleeping pattern but could be endured; and 7–10 points, intense pain that could not be endured.

Statistical analysis

The statistical analysis was performed with STATA11.0 software (http://www.stata.com), the t-test of sample mean was applied for expressing the measurement data and indicating the comparison between groups. The enumeration data were expressed with a relative number, and the comparison between groups was made based on the Chi-square test. P <0.05 indicated a statistical difference.


 > Results Top


General characteristics of the two groups

The general information of the two groups were demonstrated [Table 1]. There was no statistical difference in the aspects of age, gender, PS score, and VAS score (P > 0.05).
Table 1: The general features of the included patients of two groups

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Visual analog scale score

The VAS pain score of the electroacupuncture group significantly decreased on day 3 (P< 0.05) [Figure 1]. However, the pain scores were not significantly different (P > 0.05) between the two groups 4 days after treatment [Table 2].
Figure 1: The comparison of visual analog scale score between the two groups after treatment

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Table 2: The visual analog scale score of the two groups after treatment

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Treatment-related adverse reactions

Following adverse reactions were observed: 3 cases of subcutaneous hemorrhage in the electroacupuncture group, 1 case of skin rashes in the control group, and 3 cases of nausea and vomiting. The incidence of adverse reactions in the two groups was 9.4% and 12.1%, respectively, without significant difference (P > 0.05).


 > Discussion Top


Cancer pain was induced by disease itself or by the mental, psychological, and social causes relevant to cancer.[5],[6] The pain would be manifested not only physically but also mentally, thereby seriously affecting their quality of life. According to the latest statistics of the American Cancer Society in 2007, more than half of 12 million new cases of patients with cancer were documented in developing countries.[7] More than 7 million patients with cancer have been reported in China.[8] 51%–62% of these patients experience different degrees of pain and >30% of them suffered from moderate and severe pain.[9] Patients also feel excruciating pain, become anxious, and lose confidence in life, and their conditions would be consequently aggravated.

Cancer pain treatment has commonly involved a three-step procedure proposed by the World Health Organization (WHO): (1) administering nonsteroidal anti-inflammatory drugs for mild pain, (2) giving weak opioid drugs for moderate pain, and (3) using strong opioid drugs for severe pain. Although the analgesic effect of this three-step treatment was good, its clinical application was still limited by its side effects. Thus, other effective and safe analgesic methods should be developed.

Acupuncture has been an important part of Chinese medicine.[10] Through its dredging and collaterals, QI and blood-activating principle, and good effects in the treatment of various pain disorders, especially in cancer pain treatment, traditional Chinese medicine provided several advantages, such as nonaddictive property, no side effects, convenient application, and low cost.[11],[12]

In this study, 65 cases of advanced hepatocellular carcinoma with cancer pain were treated through fentanyl transdermal patch or electroacupuncture with multiple acupoint stimulation. Our research revealed that electroacupuncture and multiple acupoint stimulation could relieve cancer pain in patients with advanced hepatocellular carcinoma, but the onset of pain relief was slow, and pain score was not significantly decreased for the first 3 days after treatment. Therefore, electroacupuncture with multiple acupoint stimulation must be combined with other analgesic methods to alleviate cancer pain in patients with advanced hepatocellular carcinoma for improving the analgesic effects. Our conclusion was consistent with previous results.[13],[14] For instance, Alimi et al.[15] randomly assigned 90 patients suffering from cancer pain to auricular point acupuncture treatment group, nonauricular point acupuncture control group, and nonauricular point sham acupuncture control group. Then, the pain 2 months after treatment was evaluated with VAS in three groups in single blind controlled trial. They found that the pain intensity in the auricular point acupuncture treatment group was decreased by 36%, but the pain intensities in the two control groups were not significantly changed. Chen Zhongjie and Zhongchao [16] randomly assigned 66 patients with advanced cancer pain into three groups according to mild, moderate, and severe pain. The patients in each group were further classified into acupuncture group and drug group. The acupuncture group was treated with the acupoint, and the drug group was administered with aspirin, codeine, and morphine per the three-step drug administration procedure recommended by the WHO. They obtained an efficiency of 94.1% for the acupuncture group and a total effective rate of 87.5% for the drug group. This result indicated that the analgesic effect of the acupuncture treatment for cancer pain was better than that of in the three-step procedure. No side effects and addiction were induced by the analgesic drug.

Although acupuncture effectively alleviated cancer pain, the pathophysiological mechanism by which pain was relieved remained unclear. A high level of pain threshold may be yielded in patients with acupuncture and moxibustion treatment, as well as leading to a change in inflammatory pain mediators in patients. Studies on acupuncture and analgesic mechanism were in the preliminary stage, and a standard experimental cancer pain model could be applied to examine the therapeutic effect and mechanism of acupuncture and moxibustion treatment for cancer pain. In the future, experimental and clinical research on mechanism should be promoted, and a reliable basis for the clinical treatment of pain should be provided.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Ye X, Lu D, Chen X, Li S, Chen Y, Deng L, et al. Amulticenter, randomized, double-blind, placebo-controlled trial of shuangbai san for treating primary liver cancer patients with cancer pain. J Pain Symptom Manage 2016;51:979-86.  Back to cited text no. 1
    
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Chwistek M. Recent advances in understanding and managing cancer pain. F1000Res 2017;6:945.  Back to cited text no. 2
    
3.
Yanju B, Yang L, Hua B, Hou W, Shi Z, Li W, et al. Asystematic review and meta-analysis on the use of traditional Chinese medicine compound Kushen injection for bone cancer pain. Support Care Cancer 2014;22:825-36.  Back to cited text no. 3
    
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Xu L, Lao LX, Ge A, Yu S, Li J, Mansky PJ, et al. Chinese herbal medicine for cancer pain. Integr Cancer Ther 2007;6:208-34.  Back to cited text no. 4
    
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Candido KD, Kusper TM, Knezevic NN. New cancer pain treatment options. Curr Pain Headache Rep 2017;21:12.  Back to cited text no. 5
    
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Yarmohammadi H, Nakamoto DA, Azar N, Hayek SM, Haaga JR. Percutaneous computed tomography guided cryoablation of the celiac plexus as an alternative treatment for intractable pain caused by pancreatic cancer. J Cancer Res Ther 2011;7:481-3.  Back to cited text no. 6
    
7.
Trescot AM, Helm S, Hansen H, Benyamin R, Glaser SE, Adlaka R, et al. Opioids in the management of chronic non-cancer pain: An update of American society of the interventional pain physicians' (ASIPP) guidelines. Pain Physician 2008;11:S5-S62.  Back to cited text no. 7
    
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Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin 2016;66:115-32.  Back to cited text no. 8
    
9.
Li YX, Yu JQ, Tang L, Xu B, Fang F, Nie HX, et al. Cancer pain management at home: Voice from an underdeveloped region of China. Cancer Nurs 2013;36:326-34.  Back to cited text no. 9
    
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Paley CA, Johnson MI, Tashani OA, Bagnall AM. Acupuncture for cancer pain in adults. Cochrane Database Syst Rev 2015;10:CD007753.  Back to cited text no. 10
    
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Lu W, Rosenthal DS. Acupuncture for cancer pain and related symptoms. Curr Pain Headache Rep 2013;17:321.  Back to cited text no. 11
    
12.
Paley CA, Johnson MI, Tashani OA, Bagnall AM. Acupuncture for cancer pain in adults. Cochrane Database Syst Rev 2011;7:CD007753.  Back to cited text no. 12
    
13.
Chiu HY, Hsieh YJ, Tsai PS. Systematic review and meta-analysis of acupuncture to reduce cancer-related pain. Eur J Cancer Care (Engl) 2017;26:1-7.  Back to cited text no. 13
    
14.
Garcia MK, Driver L, Haddad R, Lee R, Palmer JL, Wei Q, et al. Acupuncture for treatment of uncontrolled pain in cancer patients: A pragmatic pilot study. Integr Cancer Ther 2014;13:133-40.  Back to cited text no. 14
    
15.
Alimi D, Rubino C, Pichard-Léandri E, Fermand-Brulé S, Dubreuil-Lemaire ML, Hill C, et al. Analgesic effect of auricular acupuncture for cancer pain: A randomized, blinded, controlled trial. J Clin Oncol 2003;21:4120-6.  Back to cited text no. 15
    
16.
Chen Zhongjie GY, Zhongchao W. Clinical observation on effects of acupuncture combined with Chinese medicine sticking for cancer pain. Clin J Chin Med 2008;28:251-3.  Back to cited text no. 16
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]



 

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