Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain: A Systematic Review and Meta-Analysis

Cancer-related pain represents one of the most challenging symptoms faced by patients and their families, affecting more than 70% of people diagnosed with the disease. Despite advances in pain management guidelines, including the World Health Organization "analgesic ladder," nearly half of patients with cancer still cannot achieve adequate pain control. In addition, traditional pharmacologic treatments often cause significant adverse effects and raise concerns about dependence, particularly in the context of the ongoing opioid crisis. Given these limitations, there is growing interest in complementary nonpharmacologic approaches, such as acupuncture and acupressure, which are already recommended by leading medical organizations such as the American Society of Clinical Oncology and the National Comprehensive Cancer Network for the management of cancer pain.

This study aimed to rigorously evaluate the existing scientific evidence on the efficacy of acupuncture and acupressure for the treatment of cancer-related pain. The investigators conducted a systematic review and meta-analysis, examining randomized clinical trials published through March 2019. To ensure a comprehensive search, both English-language databases (PubMed, Embase, and CINAHL) and Chinese databases (four major biomedical databases) were searched, recognizing the importance of traditional Chinese medicine in this area. The included studies compared acupuncture and acupressure with placebo controls (sham acupuncture), conventional analgesic therapy, or usual care.

Only studies that assessed pain intensity using validated scales, such as the Visual Analog Scale and the Numerical Rating Scale, were included. The methodological quality of the studies was rigorously assessed using standardized, internationally recognized tools.

The analysis included 17 randomized clinical trials involving 1,111 patients with cancer, of which 14 studies with 920 patients provided sufficient data for statistical meta-analysis. The results showed promising evidence for the efficacy of these therapies. When compared with sham acupuncture, true acupuncture demonstrated a significant reduction in pain intensity, with a mean decrease of 1.38 points on the 0-10 scale. Although this difference may seem modest numerically, it represents clinically relevant relief for patients with moderate to severe pain.

In addition, when acupuncture or acupressure were combined with traditional analgesic medications, patients experienced not only greater pain relief (mean reduction of 1.44 points) but were also able to significantly decrease opioid use, with a mean reduction of 30 mg of morphine equivalent per day. This reduction in medication use is particularly important given the risks of dependence and adverse effects associated with potent analgesics.

The clinical implications of these findings are substantial for both patients and healthcare professionals. For patients, these results suggest that acupuncture and acupressure may offer a safe and effective treatment option, either as a complementary therapy to conventional medications or, in some cases, as an alternative that allows reduced reliance on analgesics. The adverse effects reported were minimal and limited mainly to mild skin discomfort at the application site, with no cases of treatment discontinuation due to adverse events. For healthcare professionals, particularly oncologists and pain specialists, these data provide robust scientific evidence for considering the incorporation of these therapies into comprehensive cancer care plans.

The possibility of reducing opioid use is especially relevant in the current context of concerns regarding the prescription of these medications. Cancer centers worldwide have already begun offering acupuncture services, although insurance coverage remains a significant obstacle for many patients.

Despite the encouraging results, the study has some important limitations that should be considered when interpreting the findings. The main limitation was considerable heterogeneity among the included studies — that is, significant differences in methods, patient types, and outcomes across the different clinical trials. This variability may reflect the complexity of cancer pain, which can vary widely depending on tumor type, disease stage, treatments received, and individual patient characteristics. Some analyses showed reduced heterogeneity when focusing on specific types of manual acupuncture or on patients with moderate to severe pain, suggesting that future research may benefit from more targeted approaches.

In addition, some studies were not blinded — that is, patients knew they were receiving true acupuncture — which may have influenced their perceptions of pain improvement. The relatively small number of studies for some specific types of cancer-related pain also limits the ability to make definitive recommendations for all clinical situations.

In conclusion, this systematic review and meta-analysis provides moderate-quality evidence that acupuncture and acupressure are significantly associated with reduced cancer-related pain and may help decrease the use of opioid analgesics. These findings support the consideration of these therapies as valuable components of a comprehensive multidisciplinary approach to cancer pain management. However, additional high-quality studies are needed, particularly focused on specific types of cancer pain and well-defined patient populations, to optimize the integration of these therapies into routine clinical practice. In the meantime, patients interested in these approaches should discuss them with their oncology care teams to determine whether they may be appropriate for their specific situation.