Cancer Pain Can Be Complex to Manage

Pain is one of the most challenging symptoms experienced by people living with cancer. It may be related to the cancer itself, its effects on surrounding tissues, or treatments such as surgery, chemotherapy, radiation therapy or hormonal therapy.

For many patients, medications remain an important part of cancer pain management. At the same time, there is growing interest in whether non-drug approaches can be safely integrated into supportive cancer care.

One approach that has received increasing scientific attention is acupuncture.

A systematic review and meta-analysis published in JAMA Oncology examined randomized clinical trials of acupuncture and acupressure for cancer-related pain and asked an important question:

Can these therapies reduce pain—and can they potentially reduce the amount of pain medication some patients require?

Key Takeaways

The analysis included 17 randomized clinical trials involving 1,111 patients with cancer.
Fourteen trials involving 920 patients provided data for the quantitative meta-analysis.

Real acupuncture was associated with greater pain reduction than sham acupuncture.
Across blinded sham-controlled trials, patients receiving real acupuncture experienced greater reductions in pain intensity.

Acupuncture combined with pain medication was also associated with improved pain outcomes.
Several trials examined acupuncture or acupressure as an addition to conventional analgesic treatment rather than as a replacement for it.

Some evidence suggested reduced opioid requirements.
Two trials reported lower opioid doses when acupuncture was added to analgesic therapy, although this finding was based on a relatively small number of studies.

The authors rated the overall evidence as moderate.
Results were encouraging, but substantial differences among the included studies mean that additional rigorous research is still needed.

What Did the JAMA Oncology Study Examine?

The study, “Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain: A Systematic Review and Meta-Analysis,” was published online in JAMA Oncology in December 2019 and appeared in the journal's 2020 volume.

Researchers searched seven English- and Chinese-language medical databases for randomized clinical trials evaluating acupuncture or acupressure for cancer-related pain.

The final systematic review included:

17 randomized clinical trials
1,111 patients with cancer

Of those studies:

14 randomized trials involving 920 patients were included in the quantitative meta-analysis.

The studies included comparisons with sham acupuncture, conventional analgesic therapy, usual care and other control groups.

What Did the Researchers Find?

Real Acupuncture vs Sham Acupuncture

One of the most clinically important questions was whether acupuncture performed better than a sham procedure.

Across seven blinded sham-controlled trials, real acupuncture was associated with a greater reduction in pain intensity.

The pooled difference favored real acupuncture by approximately 1.38 points, with a 95% confidence interval of 0.64 to 2.13 points in favor of acupuncture.

This is important because sham-controlled trials are designed to separate the effects of acupuncture from some of the nonspecific effects associated with receiving a treatment.

However, the results varied substantially among the individual studies, which is one reason the authors did not classify the evidence as high certainty.

What Happened When Acupuncture Was Added to Pain Medication?

Another group of studies examined a different clinical question:

Rather than replacing conventional pain treatment, what happens when acupuncture or acupressure is added to analgesic therapy?

Across six randomized trials, the combination was associated with greater reductions in pain intensity than analgesic treatment alone.

The pooled difference was approximately 1.44 points in favor of the integrative treatment approach.

This finding is particularly relevant to cancer care because acupuncture is generally considered as a supportive therapy used alongside appropriate oncology and pain management, rather than as a substitute for medical treatment.

Could Acupuncture Reduce the Need for Opioid Medication?

The researchers also examined whether integrating acupuncture into cancer pain management might affect analgesic requirements.

Two randomized trials reported opioid use in a form that could be combined statistically.

In those studies, patients receiving acupuncture together with analgesic therapy used an average of approximately 30 mg less morphine-equivalent medication per day than patients receiving analgesic therapy alone.

This finding is interesting, but it needs to be interpreted carefully.

Because the opioid analysis was based on only two trials, it should not be interpreted to mean that acupuncture will reduce opioid requirements for every patient with cancer.

More importantly, patients undergoing cancer treatment should never reduce or discontinue prescribed pain medication on the basis of acupuncture treatment without discussing the change with their oncology or pain-management team.

How Strong Is the Evidence?

The authors ultimately classified the overall evidence as moderate.

That distinction matters.

The study found statistically significant associations between acupuncture or acupressure and improved cancer pain outcomes, but the individual trials differed in several important ways—including patient populations, treatment approaches and study methodology.

There was also substantial statistical heterogeneity in some of the pooled analyses.

For that reason, the study provides meaningful evidence supporting acupuncture as a potential component of cancer pain management, but it does not establish that every type of cancer pain or every patient will respond in the same way.

The authors concluded that further rigorous clinical trials are needed to better understand which patients and which types of cancer pain are most likely to benefit.

What Do More Recent Oncology Guidelines Say?

Since the publication of the JAMA Oncology meta-analysis, acupuncture has continued to be evaluated within mainstream oncology supportive care.

In 2022, the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) jointly published an evidence-based clinical practice guideline on integrative approaches to pain management in oncology.

The guideline, “Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology–ASCO Guideline,” reviewed systematic reviews, meta-analyses and randomized clinical trials published through 2021.

For adults experiencing general cancer pain or musculoskeletal pain related to cancer, the guideline states that:

Acupuncture may be offered as part of pain management.

The guideline rated the evidence supporting this recommendation as intermediate, with a moderate strength of recommendation.

This is important because it places acupuncture within a broader contemporary approach to supportive oncology care rather than viewing it simply as an alternative therapy outside conventional cancer treatment.

What Does This Mean for Patients With Cancer Pain?

The research does not suggest that acupuncture should replace oncology treatment or medically appropriate pain medication.

Instead, the evidence supports a different role:

Acupuncture may be considered as one component of an integrative cancer pain management strategy.

For some patients, that may mean using acupuncture alongside medication, rehabilitation, physical activity, psychological support, palliative care or other appropriate treatments.

The goals may include:

reducing pain intensity,
improving everyday function and comfort,
supporting quality of life,
and potentially reducing reliance on pain medication when medically appropriate.

Cancer pain is highly individualized, however, and treatment decisions should take into account the type of cancer, the source of pain, ongoing cancer treatments, medications and the patient's overall medical condition.

Acupuncture Is Supportive Care — Not Cancer Treatment

This distinction is especially important.

Acupuncture does not treat the cancer itself.

It should not be presented as a replacement for chemotherapy, radiation therapy, surgery, immunotherapy, hormonal therapy or other medically indicated cancer treatment.

Its potential role is in supportive care—helping manage symptoms such as pain while the patient continues appropriate oncology care.

Patients undergoing active cancer treatment should also keep their oncology team informed when adding acupuncture or other supportive therapies to their care plan.

Our Perspective

At Balance Art Acupuncture, we believe that the most useful question is not whether acupuncture should replace conventional cancer pain treatment.

The more clinically meaningful question is:

Can acupuncture be safely and appropriately integrated into a patient's existing care to help manage pain and improve quality of life?

The JAMA Oncology systematic review provides moderate-level evidence suggesting that acupuncture may help reduce cancer-related pain, while later SIO-ASCO clinical guidance recognizes acupuncture as an option that may be offered to adults experiencing general cancer pain or cancer-related musculoskeletal pain.

For appropriate patients, acupuncture can therefore be considered as part of a multidisciplinary and evidence-informed supportive care plan, coordinated with the patient's oncology and medical team.

 

References & Original Sources

1. He et al. — JAMA Oncology Systematic Review & Meta-Analysis

He Y, Guo X, May BH, et al.
Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain: A Systematic Review and Meta-Analysis.
JAMA Oncology. 2020;6(2):271–278.
DOI: 10.1001/jamaoncol.2019.5233

JAMA Oncology — Original Article

PubMed

PMC — Free Full Text

2. SIO-ASCO Clinical Practice Guideline

Mao JJ, Ismaila N, Bao T, et al.
Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology–ASCO Guideline.
Journal of Clinical Oncology. 2022;40(34):3998–4024.
DOI: 10.1200/JCO.22.01357

Journal of Clinical Oncology — Original Guideline

PubMed​

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Considering Acupuncture as Part of Cancer Pain Support?

If you are experiencing pain related to cancer or cancer treatment, acupuncture may be one supportive option to discuss with your healthcare team.

At Balance Art Acupuncture in Vienna, Virginia, treatment is individualized based on each patient's symptoms, medical history and current care plan.

For patients undergoing cancer treatment, acupuncture should be coordinated with appropriate medical and oncology care.

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