Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors The PEACE Randomized Clinical Trial
Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors The PEACE Randomized Clinical Trial
复制标题
PEACE随机临床试验：电针或耳针与常规护理治疗癌症幸存者慢性肌肉骨骼疼痛的有效性
DOI：
10.1001/jamaoncol.2021.0310
复制
发表时间：
2021-03-18
期刊：
影响因子：
28.4
通讯作者：
Kantoff, Philip W.
中科院分区：
文献类型：
--
作者：
Mao, Jun J.;Liou, Kevin T.;Kantoff, Philip W.
阿片类药物危机为癌症疼痛管理带来了挑战。针灸对慢性非恶性疼痛具有临床疗效，但其对癌症幸存者的有效性仍不确定。目的探讨电针或耳针治疗癌症幸存者慢性肌肉骨骼疼痛的疗效。个性化电针与耳针比较有效性（PEACE）试验是一项随机临床试验，于2017年3月至2019年10月（随访于2020年4月完成）在纽约和新泽西的一个城市学术癌症中心和5个郊区站点进行。研究统计学家对治疗分配不知情。研究中包括的360名成年人先前有癌症诊断，但目前没有疾病证据，报告肌肉骨骼疼痛至少3个月，并在简短疼痛量表（BPI）中自我报告疼痛强度，范围从0（无痛）到10（可想象的最严重疼痛）。干预措施患者按2:2:1随机分为电针组（145例）、耳针组（143例）和常规护理组（72例）。干预组每周接受10次电针或耳针治疗。从第12周到第24周，常规护理组接受10次针灸治疗。主要结局和测量主要结局是BPI平均疼痛严重程度评分从基线到第12周的变化。采用守门多重比较程序，使用线性混合模型比较电针和耳针的常规护理。耳针对电针的非劣效性进行了测试，如果两种干预措施都优于常规护理。在360名癌症幸存者中（平均[SD]年龄为62.1[12.7]岁；平均[SD]基线BPI评分为5.2[1.7]分；251名[69.7%]女性；88名[24.4%]非白人），340名（94.4%）完成了主要终点。与常规护理相比，电针可减轻疼痛严重程度1.9个点(97.5% CI, 1.4 ~ 2.4个点
IMPORTANCE The opioid crisis creates challenges for cancer pain management. Acupuncture confers clinical benefits for chronic nonmalignant pain, but its effectiveness in cancer survivors remains uncertain.OBJECTIVE To determine the effectiveness of electroacupuncture or auricular acupuncture for chronic musculoskeletal pain in cancer survivors.DESIGN, SETTING, AND PARTICIPANTS The Personalized Electroacupuncture vs Auricular Acupuncture Comparativeness Effectiveness (PEACE) trial is a randomized clinical trial that was conducted from March 2017 to October 2019 (follow-up completed April 2020) across an urban academic cancer center and 5 suburban sites in New York and New Jersey. Study statisticians were blinded to treatment assignments. The 360 adults included in the study had a prior cancer diagnosis but no current evidence of disease, reported musculoskeletal pain for at least 3 months, and self-reported pain intensity on the Brief Pain Inventory (BPI) ranging from 0 (no pain) to 10 (worst pain imaginable).INTERVENTIONS Patients were randomized 2:2:1 to electroacupuncture (n = 145), auricular acupuncture (n = 143), or usual care (n = 72). Intervention groups received 10 weekly sessions of electroacupuncture or auricular acupuncture. Ten acupuncture sessions were offered to the usual care group from weeks 12 through 24.MAIN OUTCOMES AND MEASURES The primary outcomewas change in average pain severity score on the BPI from baseline to week 12. Using a gatekeeping multiple-comparison procedure, electroacupuncture and auricular acupuncture were compared with usual care using a linear mixed model. Noninferiority of auricular acupuncture to electroacupuncture was tested if both interventions were superior to usual care.RESULTS Among 360 cancer survivors (mean [SD] age, 62.1 [12.7] years; mean [SD] baseline BPI score, 5.2 [1.7] points; 251 [69.7%] women; and 88 [24.4%] non-White), 340 (94.4%) completed the primary end point. Compared with usual care, electroacupuncture reduced pain severity by 1.9 points (97.5% CI, 1.4-2.4 points; P