Effect of acupuncture versus usual care on sleep quality in cancer survivors with chronic pain: Secondary analysis of a randomized clinical trial

Sleep quality represents one of the greatest concerns among cancer survivors, especially for those living with chronic pain. It is estimated that about 60% of cancer survivors face sleep disturbances, a problem that can persist for years after the diagnosis and treatment of the disease. The relationship between pain and sleep is particularly complex, since pain can interfere with sleep quality, while poor sleep quality can also intensify pain perception. For many patients, this combination creates a cycle that is difficult to break, where one problem feeds the other.

Traditionally, pharmacologic treatments have been the most common approach, but many cancer survivors seek non-pharmacologic alternatives to avoid the side effects of sleep medications or concerns related to the combined use of multiple medications.

This study represented a secondary analysis of the PEACE clinical trial, which originally investigated the effects of two types of acupuncture in relieving chronic musculoskeletal pain in cancer survivors. The researchers decided to specifically examine how this pain intervention could impact participants' sleep quality. The aim was to compare the effect of electroacupuncture and auricular acupuncture with usual care on improving sleep quality among cancer survivors who had both sleep disturbances and chronic pain. The study included 268 participants with a mean age of 61 years, most of whom were women, who had been suffering from musculoskeletal pain for at least three months and had a score of 6 or higher on the Pittsburgh Sleep Quality Index, indicating poor sleep quality.

Participants were divided into three groups: electroacupuncture, auricular acupuncture, and usual care. Sleep quality was assessed at baseline, after 10 weeks of treatment, and again after 24 weeks, using validated questionnaires that measure different aspects of sleep.

The study results showed that both types of acupuncture produced significant improvements in sleep quality when compared with usual care. After 10 weeks of treatment, participants who received electroacupuncture showed a mean reduction of 1.42 points on the sleep quality scale, while those who received auricular acupuncture had a reduction of 1.59 points, compared with the control group. These improvements were not only statistically significant but were also maintained up to 24 weeks after the start of treatment, demonstrating that the benefits of acupuncture persist even after the end of sessions. In addition, a significantly larger proportion of patients in the acupuncture groups experienced clinically important improvements in sleep quality: 41% in the electroacupuncture group and 43% in the auricular acupuncture group, compared with only 21% in the usual care group.

The researchers also found an interesting relationship between pain relief and sleep improvement, observing that patients who responded better to pain treatment also showed greater improvements in sleep quality.

From a clinical standpoint, these findings offer a promising perspective for cancer survivors who face the dual challenge of chronic pain and sleep disturbances. Acupuncture emerges as an evidence-based treatment option that can simultaneously address both problems, offering a non-pharmacologic alternative especially valuable for patients who already take multiple medications or who prefer to avoid sleep medications because of their potential side effects. The results suggest that by effectively treating pain through acupuncture, it is possible to obtain secondary benefits in sleep quality, supporting the theory that pain and sleep are closely connected through common neurobiological pathways. For health professionals, these data provide solid evidence to consider acupuncture as part of a comprehensive care plan for cancer survivors, especially those with combined complaints of pain and sleep disturbances.

It is important to acknowledge some significant limitations of this study. First, because it is a secondary analysis of data from a clinical trial originally designed to study pain, the results should be interpreted as exploratory and hypothesis-generating rather than conclusive. The study did not include a placebo group with sham acupuncture, which means that it is not possible to completely separate the specific effects of acupuncture from other factors such as therapeutic attention and patient expectations. In addition, the study did not use objective sleep measures such as polysomnography or actigraphy, relying only on self-report questionnaires.

Despite the observed improvements, the magnitude of the effect was moderate, and many patients still did not achieve complete remission of sleep disturbances. This suggests that, although acupuncture is beneficial, it may be more effective when combined with other evidence-based approaches for the treatment of sleep disturbances. Future studies will be necessary to confirm these findings and explore how acupuncture can be better integrated with other therapies to maximize benefits for both pain and sleep in cancer survivors.