Up to 50% of women receiving aromatase inhibitor (AI) complain of AI-associated musculoskeletal symptoms (AIMSS) and 15% discontinue treatment. We conducted a randomized, sham-controlled trial to evaluate whether acupuncture improves AIMSS and to explore potential mechanisms.
Patients and Methods
Postmenopausal women with early stage breast cancer, experiencing AIMSS were randomized to 8 weekly real or sham acupuncture sessions. We evaluated changes in the Health Assessment Questionnaire Disability Index (HAQ-DI) and pain visual analog scale (VAS) following the intervention compared to baseline. Serum estradiol, β-endorphin and proinflammatory cytokine concentrations were measured pre and post-intervention.
We enrolled 51 women, of whom 47 were evaluable, including 23 randomized to real and 24 to sham acupuncture. Baseline characteristics were balanced between groups with the exception of a higher HAQ-DI score in the real acupuncture group (p=0.047). We did not observe a statistically significant difference in reduction of HAQ-DI (p=0.30) or VAS (p=0.31) between the two groups. Following 8 weekly treatments, we observed a statistically significant reduction of IL-17 (p≤0.009) in both groups. No significant modulation was seen in estradiol, β-endorphin, or other proinflammatory cytokine concentrations in either group.
We did not observe a significant difference in AIMSS changes between real and sham acupuncture. As sham acupuncture used in this study may not be equivalent to placebo, further studies with a non-acupuncture arm may be required to establish whether acupuncture is beneficial for the treatment of AIMSS.