Acupuncture treatment for post-thoracotomy pain syndrome

描述(申请人提供)：背景：开胸术后疼痛综合征影响许多肺癌患者和幸存者。在一些患者中，尽管目前有治疗方法，但症状持续时间长且难治，对他们的生活质量有重大影响。在治疗某些类型的疼痛时，针灸可以是一种有效的补充方式。癌症患者的术后疼痛和神经病理性疼痛都被证明对针灸治疗有反应。我们已经进行了一项初步研究，测试围手术期植入皮内小针头以减轻开胸手术后疼痛的可行性。我们发现这种干预在目前的临床实践环境下是可行的，并受到患者和外科医生的好评。 目的：我们建议进行一项随机对照研究，以进一步评价这种针灸技术对开胸术后疼痛综合征的疗效。其具体目标是：1)确定与安慰剂相比，使用皮内针刺针的针灸是否可以减少开胸手术后的慢性疼痛；2)确定与安慰剂相比，使用皮内针刺针的针灸是否可以减少开胸手术后的急性疼痛。 方法：对140例开胸手术的癌症患者进行前瞻性、随机、安慰剂对照的针灸干预研究。小的皮内针灸针头或安慰剂针头将在手术前主要沿脊柱放置。这些针头总共在原地停留了四周。疼痛数字评定量表、简明疼痛问卷(BPI)、阿片类药物和非阿片类止痛药的使用情况将在基线和术后进行评估。主要比较真针刺组和安慰剂针刺组在第30天的BPI评分。 意义：开胸术后疼痛综合征是肺癌手术治疗中难以治疗的后遗症。这项拟议的研究将测试针灸这一补充疗法在治疗这一症状方面的有效性。如果结果是有希望的，我们将建议进行一项大型的多机构随机试验。这项研究有可能导致一种新的治疗选择，以改善癌症患者和癌症幸存者的生活质量。

DESCRIPTION (provided by applicant): Background: Post-thoracotomy pain syndrome affects many lung cancer patients and survivors. In some patients, the symptom is long-lasting and refractory despite currently available treatment, having a significant impact on their quality of life. Acupuncture can be an effective complementary modality in the management of certain types of pain. Both post-operative pain and neuropathic pain in cancer patients have been shown to respond to acupuncture treatment. We have conducted a pilot study testing the feasibility of planting small intradermal acupuncture needles perioperatively to reduce post-thoracotomy pain. We found the intervention feasible in the current clinical practice setting and well received by patients and surgeons. Objectives: We propose to conduct a randomized controlled study to further evaluate the effectiveness of such acupuncture technique for post-thoracotomy pain syndrome. The specific aims are to 1) determine whether acupuncture using intradermal acupuncture needles reduces chronic post-thoracotomy pain compared to placebo; 2) determine whether acupuncture using intradermal acupuncture needles reduces acute post-thoracotomy pain compared to placebo. Methods: A prospective, randomized placebo-controlled intervention study of acupuncture in 140 cancer patients undergoing thoracotomy. Small intradermal acupuncture needles or placebo needles will be placed mainly along the spine prior to surgery. The needles stay in place for a total of four weeks. Numerical rating scale of pain, Brief Pain Inventory (BPI), use of opioids and non-opioids analgesics will be evaluated at baseline and postoperatively. The primary comparison is BPI scores at Day 30 between the true acupuncture group and the placebo acupuncture group. Significance: Post-thoracotomy pain syndrome is a difficult-to-treat sequela of surgical treatment of lung cancer. The proposed study will test the effectiveness of acupuncture, a complementary modality, in treating this symptom. If results are promising, we would propose a large, multi-institutional randomized trial. The research has the potential of leading to a new treatment option to improve the quality of life of cancer patients and cancer survivors.