Cancer survivors face a challenge that goes beyond disease remission: chronic musculoskeletal pain — present in 30% to 40% of this population — progressively compromises limb function, reduces the ability to perform daily activities, and substantially worsens quality of life. The PEACE trial (Personalized Electro-acupuncture versus Auricular Acupuncture Comparative Effectiveness), conducted at Memorial Sloan Kettering Cancer Center in New York between 2017 and 2019, was the largest randomized clinical trial up to that point comparing two acupuncture modalities with a control group in cancer survivors with chronic pain. A secondary analysis published in November 2025 in the journal Current Oncology adds a fundamental dimension to the original study: functional recovery of upper and lower limbs.
The work, coordinated by Lingyun Sun (Xiyuan Hospital, China Academy of Chinese Medical Sciences) and Jun J. Mão (Memorial Sloan Kettering), analyzed 360 patients with a prior cancer diagnosis and chronic musculoskeletal pain (duration >3 months, BPI >4). The mean age was 62.1 ± 12.7 years; 69.7% were women and 24.4% were non-white. The most prevalent cancer type was breast (45.8%), followed by lymphoma (14.2%), prostate (11.4%), and others. Patients were randomized in a 2:2:1 ratio to electroacupuncture (EA, n=145), auricular acupuncture (AA, n=143), or waitlist (control, n=72).
FUNCTIONAL IMPROVEMENT VS. CONTROL (WAITLIST) — WEEK 12
The PEACE Trial and Its Treatment Arms
Patients in the electroacupuncture group received 10 sessions of 30 minutes over 10 weeks, with electrical stimulation of 2 Hz applied at four acupoints near the área of greatest pain. The auricular acupuncture group received the “battlefield acupuncture” protocol — originally developed for pain treatment in military settings — with up to 10 semipermanent needles at specific auricular acupoints, kept in place for 3 to 4 days between sessions. The control group (waitlist) maintained their usual pain management, including medications, physical therapy, or injections, without restriction.
Functional outcomes were assessed by two widely validated scales: the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) for upper-limb function (0–100, higher values = greater disability) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) — physical function subscale — for lower limbs (0–100, higher values = greater disability). Patients were assessed at weeks 4, 10, 12, 16, and 24.
Upper vs. Lower Limbs: Distinct Recovery Patterns
Both modalities showed significant benefits in upper limbs (Q-DASH) and lower limbs (WOMAC) at week 12, with no difference between EA and AA on the two outcomes (Q-DASH p=0.068; WOMAC p=0.61). However, the patterns of maintenance over time differed between anatomical segments. For upper limbs, gains in Q-DASH peaked at week 10 (EA: −9.42; AA: −10.85 vs. control), were maintained at week 12, and showed partial decline at week 24 (EA: −7.46; AA: −9.89), with a significant increase of approximately 2.4 points in both groups (p ≈ 0.02) — indicating that benefits for upper limbs gradually diminish after the end of sessions.
For lower limbs (WOMAC), the pattern was more favorable: the gains at week 12 (EA: −10.73; AA: −11.45 vs. control) were maintained essentially stable through week 24 (EA: −10.32; AA: −9.78), with no statistically significant decline. Both acupuncture groups reached at week 12 the minimum clinically important difference (MCID) established at 11 points for WOMAC — a threshold the control group did not reach at any point during follow-up.
Frequently Asked Questions
The PEACE trial was conducted with cancer survivors (most not in active chemotherapy treatment), but the safety literature in active oncology is broad. In immunosuppressed patients or those with reduced platelet counts, the medical acupuncturist should adapt the protocol: avoid needling in áreas of lymphedema, respect the platelet threshold (generally >50,000/μL for standard acupuncture), and prefer auricular acupressure with seeds (not needles) in patients with severe neutropenia. The decision should be individualized and integrated with the responsible oncology team.
The Quick-DASH (Quick Disabilities of the Arm, Shoulder and Hand) is an abbreviated 11-item version of the DASH instrument, which assesses the ability to perform daily activities with the upper limbs (writing, carrying objects, opening doors). The scale ranges from 0 (no disability) to 100 (maximum disability). The Minimum Clinically Important Difference (MCID) is 12 to 15 points. In this study, the gains for electroacupuncture (−7.18) fell below the MCID, while those for auriculotherapy (−9.64) approached the threshold. This indicates a statistically significant and clinically relevant improvement for most patients, although not all reach the threshold of patient-perceptible change.
The authors speculate that the difference may reflect distinctions in biomechanics and pain pathophysiology: knee/hip pain (predominant in the lower limbs of the sample) often has an inflammatory and joint component that responds with greater durability to the neuroinflammatory modulation of acupuncture, while shoulder/arm pain (frequent in breast cancer survivors) may have a larger component of central hypersensitivity and peripheral neuropathy, more prone to recurrence. This hypothesis requires confirmation in dedicated studies.
Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).
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