Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors: The PEACE Randomized Clinical Trial

Chronic pain represents one of the greatest challenges faced by cancer survivors, affecting approximately half of this growing population worldwide. Unlike the general population, these patients carry an additional burden of suffering related to prior cancer treatments, such as surgeries, chemotherapy, radiation therapy, and hormonal therapies, which can leave lasting painful sequelae. Inadequately treated pain significantly compromises quality of life, impairs physical function, and may even negatively influence cancer-related outcomes. With the current opioid crisis in the United States, it has become even more urgent to find effective non-pharmacological alternatives for pain management, especially considering that nearly half of cancer survivors do not receive adequate treatment for their painful symptoms.

The PEACE (Personalized Electroacupuncture vs Auricular Acupuncture Comparative Effectiveness) study was conducted to evaluate the effectiveness of two acupuncture techniques in the treatment of chronic musculoskeletal pain in cancer survivors. This randomized clinical trial involved 360 adults who had been treated for cancer but had no current evidence of disease, all suffering from musculoskeletal pain for at least three months. The study was conducted between March 2017 and October 2019, distributed between the urban center of Memorial Sloan Kettering Cancer Center and five suburban sites in New York and New Jersey. Participants were randomly divided into three groups: electroacupuncture (145 patients), auricular acupuncture (143 patients), and usual care (72 patients).

The acupuncture groups received ten weekly sessions of treatment, while the usual care group continued with the standard treatment prescribed by their physicians, including analgesic medications, physical therapy, and injections when necessary.

The results demonstrated significant benefits for both acupuncture techniques. In electroacupuncture, licensed acupuncturists selected specific points near the painful area and additional points in other parts of the body, applying electrical stimulation at some points for 30 minutes. Auricular acupuncture followed a standardized military protocol known as "battlefield acupuncture," focusing exclusively on specific points on the ears, with shorter sessions of 10 to 20 minutes. After 12 weeks of treatment, both techniques produced clinically significant reductions in pain intensity compared to usual care.

Electroacupuncture reduced pain scores by 1.9 points on a 0-10 scale, while auricular acupuncture reduced 1.6 points. To put these numbers in context, a 1-point reduction on this scale is considered clinically relevant by experts. In addition to pain improvement, both treatments also resulted in better quality of life, greater functional capacity, and reduced use of analgesic medications.

For patients and healthcare professionals, these findings offer promising perspectives in the management of chronic pain in cancer survivors. Electroacupuncture proved to be particularly effective and well tolerated, with only one patient discontinuing treatment due to mild adverse effects, mainly bruising at needle sites. Auricular acupuncture, although also effective, had a higher discontinuation rate, with 15 patients discontinuing treatment due primarily to ear pain. Importantly, the benefits of both techniques persisted up to 24 weeks after treatment initiation, suggesting long-lasting effects.

These results are especially relevant considering that Medicare in the United States recently began covering acupuncture for chronic low back pain, and studies like this strengthen the argument for expanding this coverage to other types of chronic pain in cancer survivors.

The study has some important limitations that should be considered. First, it was not possible to apply a true placebo control, since both patients and acupuncturists knew which treatment was being applied, which may introduce some bias into the results. Second, the treatments were applied by experienced and licensed acupuncturists, so the effects may differ if auricular acupuncture is applied by professionals without specific training in acupuncture, as is being implemented in the U.S. military system.

Third, the study was conducted at an academic cancer center with urban and suburban locations, with additional research needed in community settings, especially in rural and underserved areas, to determine whether the results can be generalized. Despite these limitations, this study represents a significant contribution to the arsenal of non-pharmacological options in the treatment of chronic pain, offering cancer survivors safe and effective alternatives that can substantially improve their quality of life without the risks associated with prolonged opioid use.