Acupuncture Relieves Opioid-Induced Constipation in Clinical Cancer Therapy - A Meta-Analysis and Systematic Review

Changhui Han; Yingjuan Liu; Huanfang Fan; Dehui Li; Na Guo

doi:10.2147/CLEP.S324193

Acupuncture Relieves Opioid-Induced Constipation in Clinical Cancer Therapy - A Meta-Analysis and Systematic Review

Clin Epidemiol. 2021 Oct 2:13:907-919. doi: 10.2147/CLEP.S324193. eCollection 2021.

Authors

Changhui Han¹, Yingjuan Liu², Huanfang Fan¹, Dehui Li¹, Na Guo¹

Affiliations

¹ Affiliated Hospital of Hebei University of Traditional Chinese Medicine, Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, People's Republic of China.
² Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.

Abstract

Cancer pain is a common problem in clinical cancer therapy. Opioid analgesia is one of the most effective drugs for pain relief with satisfying performance besides the side effect of opioid-induced constipation (OIC). Acupuncture, as a Chinese traditional non-invasive intervention, has been applied to clinical cancer pain management and functional constipation therapy. However, only a few studies have adopted this treatment for OIC patients. Due to limited numbers of investigated subjects and variability of application methods, including treatment apparatus, acupoints, durations, and sessions, the interpretation of acupuncture's therapy effects from single-site randomized clinical trials (RCT) is limited. Therefore, we conducted a meta-analysis by collecting published data from Pubmed, Embase, Cochrane library, and Web of Science. Five RCTs focusing on the application of acupuncture with or without medication in OIC patients were included. An overall remission rate of 86.8% in the acupuncture-treated group was achieved, higher than the control group (78.9%; RR, 1.10, 95% CI [1.03, 1.18]). The symptom scores, reporting on defecation frequency, defecation straining, abdominal pain, defection time, and stool property, in acupuncture groups were lower than control groups with a standardized mean difference (SMD) of -2.21 [-4.15, -0.27]. The quality of life (QOL) for patients in the acupuncture treated group increased compared to the control group with reduced PAC-QOL scores (SMD, -1.02 [-1.78, -0.26]). Referring to the effects from pure acupuncture treatment (SMD, -0.43 [-0.83, -0.03]), the co-intervention of acupuncture and drugs (SMD, -1.77 [-2.51, -1.02]) improved the life quality of patients more remarkably (P < 0.05). Overall, our data confirmed the therapeutic effects of acupuncture in the treatment of OIC. The co-intervention of acupuncture with drugs improves the outcomes of OIC patients better than a single strategy. Combined therapy with both medicine and acupuncture has insightful potential for future clinical cancer patient management on constipation problems.

Keywords: acupuncture; cancer; meta-analysis; opioid-induced constipation; pain.

Publication types

Review

Grants and funding

This work was supported by the Scientific Research Project of Hebei Administration of Traditional Chinese Medicine (Grants No. 2019030). The funding body played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.