Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer: The IMPACT Randomized Clinical Trial.
Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer: The IMPACT Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2023.42482
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发表时间：
2023-11-01
影响因子：
13.8
通讯作者：
Mao, Jun J.
中科院分区：
文献类型：
--
作者：
Epstein, Andrew S.;Liou, Kevin T.;Romero, Sally A. D.;Baser, Raymond E.;Wong, Greta;Xiao, Han;Mo, Zunli;Walker, Desiree;MacLeod, Jodi;Li, Qing;Barton-Burke, Margaret;Deng, Gary E.;Panageas, Katherine S.;Farrar, John T.;Mao, Jun J.
针灸推拿治疗晚期癌症患者癌痛的疗效如何？在这项包括298名晚期癌症患者的随机临床试验中，针灸和按摩都与长期疼痛减轻有关。两组间无显著差异。本研究的结果表明，针灸和按摩可以作为晚期癌症患者的综合治疗方式来缓解疼痛。对于晚期癌症患者来说，疼痛是一个挑战。虽然最近的指南推荐针灸和按摩治疗癌症疼痛，但它们的相对效果尚不清楚。比较针灸和按摩对晚期癌症患者肌肉骨骼疼痛的影响。2019年9月19日至2022年2月23日，在美国东北部综合癌症中心和东南部癌症研究所组成的癌症护理中心进行了一项多中心实用随机临床试验。主要研究者和研究统计人员对治疗任务不知情。随访26周。进行意向治疗分析（线性混合模型）。参与者包括患有中度至重度疼痛的晚期癌症患者，临床估计寿命为6个月或更长。患者招募策略是多管齐下的（例如，患者数据库查询，邮寄，转诊，社区外展）。符合条件的患者以英语或西班牙语为第一语言，年龄大于18岁，Karnofsky评分大于或等于60（范围0-100；分数越高表明功能损害越小）。每周进行10周的针灸或按摩，每月进行26周的强化治疗。主要终点是最严重疼痛强度评分从基线到26周的变化。次要结局包括疲劳、失眠和生活质量。简要疼痛量表（范围0-10；数值越高表明疼痛强度或干扰越严重）用于衡量主要结果。次要结局包括疲劳、失眠和生活质量。共纳入298名参与者（平均[SD]年龄58.7[14.1]岁，200[67.1%]为女性，33[11.1%]为黑人，220[74.1%]为白人，46[15.4%]为西班牙裔，78.5%为实体瘤）。平均（SD）基线最差疼痛评分为6.9分（1.5分）。在26周期间，针灸降低了最严重疼痛评分，平均变化为- 2.53 （95% CI, - 2.92至- 2.15）分，按摩降低了简短疼痛量表最严重疼痛评分，平均变化为- 3.01 （95% CI, - 3.38至- 2.63）分；组间差异无统计学意义（- 0.48;95% CI, - 0.98 ~ 0.03; P = .07）。两种治疗方法也改善了疲劳、失眠和生活质量，组间无显著差异。不良事件轻微，包括瘀伤（接受针灸的患者占6.5%）和短暂性疼痛（接受按摩的患者占15.1%）。在这项针对晚期癌症患者的随机临床试验中，针灸和按摩在26周内都与减轻疼痛、改善疲劳、失眠和生活质量有关；但两组间无显著差异。需要更多的研究来评估如何最好地将这些方法整合到疼痛治疗中，以优化越来越多的晚期癌症患者的症状管理。这项随机临床试验比较了针灸和按摩治疗晚期癌症患者肌肉骨骼疼痛的有效性。
What is the effectiveness of acupuncture and massage for cancer pain in patients with advanced cancer? In this randomized clinical trial that included 298 patients with advanced cancer, both acupuncture and massage were associated with long-term pain reduction. There was no significant difference between treatments. The findings of this study suggest that both acupuncture and massage may offer pain relief as integrative modalities in patients with advanced cancer. Pain is challenging for patients with advanced cancer. While recent guidelines recommend acupuncture and massage for cancer pain, their comparative effectiveness is unknown. To compare the effects of acupuncture and massage on musculoskeletal pain among patients with advanced cancer. A multicenter pragmatic randomized clinical trial was conducted at US cancer care centers consisting of a northeastern comprehensive cancer center and a southeastern cancer institute from September 19, 2019, through February 23, 2022. The principal investigator and study statisticians were blinded to treatment assignments. The duration of follow-up was 26 weeks. Intention-to-treat analyses were performed (linear mixed models). Participants included patients with advanced cancer with moderate to severe pain and clinician-estimated life expectancy of 6 months or more. Patient recruitment strategy was multipronged (eg, patient database queries, mailings, referrals, community outreach). Eligible patients had English or Spanish as their first language, were older than 18 years, and had a Karnofsky score greater than or equal to 60 (range, 0-100; higher scores indicating less functional impairment). Weekly acupuncture or massage for 10 weeks with monthly booster sessions up to 26 weeks. The primary end point was the change in worst pain intensity score from baseline to 26 weeks. The secondary outcomes included fatigue, insomnia, and quality of life. The Brief Pain Inventory (range, 0-10; higher numbers indicate worse pain intensity or interference) was used to measure the primary outcome. The secondary outcomes included fatigue, insomnia, and quality of life. A total of 298 participants were enrolled (mean [SD] age, 58.7 [14.1] years, 200 [67.1%] were women, 33 [11.1%] Black, 220 [74.1%] White, 46 [15.4%] Hispanic, and 78.5% with solid tumors). The mean (SD) baseline worst pain score was 6.9 (1.5). During 26 weeks, acupuncture reduced the worst pain score, with a mean change of −2.53 (95% CI, −2.92 to −2.15) points, and massage reduced the Brief Pain Inventory worst pain score, with a mean change of −3.01 (95% CI, −3.38 to −2.63) points; the between-group difference was not significant (−0.48; 95% CI, −0.98 to 0.03; P = .07). Both treatments also improved fatigue, insomnia, and quality of life without significant between-group differences. Adverse events were mild and included bruising (6.5% of patients receiving acupuncture) and transient soreness (15.1% patients receiving massage). In this randomized clinical trial among patients with advanced cancer, both acupuncture and massage were associated with pain reduction and improved fatigue, insomnia, and quality of life over 26 weeks; however, there was no significant different between the treatments. More research is needed to evaluate how best to integrate these approaches into pain treatment to optimize symptom management for the growing population of people living with advanced cancer. ClinicalTrials.gov Identifier: NCT04095234 This randomized clinical trial compares the effectiveness of acupuncture and massage as treatment for musculoskeletal pain in patients with advanced cancer.
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影响因子：
7.4
作者：
MacPherson H;Vertosick EA;Foster NE;Lewith G;Linde K;Sherman KJ;Witt CM;Vickers AJ;Acupuncture Trialists' Collaboration
通讯作者：
Acupuncture Trialists' Collaboration
影响因子：
--
作者：
Mallinckrodt, Craig H.;Lane, Peter W.;Mancuso, James P.
通讯作者：
Mancuso, James P.
DOI：
10.1177/1049909110391464
发表时间：
2011-08-01
影响因子：
1.9
作者：
Kirkova, Jordanka;Rybicki, Lisa;Karafa, Matthew T.
通讯作者：
Karafa, Matthew T.
影响因子：
28.4
作者：
Mao, Jun J.;Liou, Kevin T.;Kantoff, Philip W.
通讯作者：
Kantoff, Philip W.
影响因子：
4.4
作者：
Johnsen, A. T.;Petersen, M. A.;Groenvold, M.
通讯作者：
Groenvold, M.