Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA.
Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Support Care Cancer. 2021 Jan;29(1):427-435. doi: 10.1007/s00520-020-05504-y. Epub 2020 May 8.
Approximately one in two cancer patients globally are under-treated for pain. Opioids and other analgesics represent the mainstay of cancer pain management; however, barriers to their use are well-documented. We evaluated whether acupuncture would be a preferable treatment option among cancer patients with attitudinal barriers to pharmacological pain management.
We conducted a cross-sectional survey of cancer patients at a tertiary urban cancer center and eleven suburban/rural hospitals in the Northeastern United States. We assessed attitudinal barriers to pharmacological pain management with the Barriers Questionnaire (BQ-13). The BQ-13 consists of two subscales: pain management beliefs and analgesic side effects. We also asked patients whether they prefer acupuncture, analgesics, or have no preference between these two modalities for pain management. Covariates included sociodemographics, clinical characteristics, and attitudes/beliefs about acupuncture. We used logistic regression to examine the association between attitudinal barriers and acupuncture preference.
Among 628 patients, 197 (31.4%) preferred acupuncture for pain management, 146 (23.3%) preferred analgesics, and 285 (45.4%) had no preference. The highest reported attitudinal barriers were fear of addiction and fear of analgesic-associated constipation and nausea. Adjusting for covariates, we found that attitudinal barriers related to fear of analgesic side effects were significantly associated with acupuncture preference (adjusted odds ratio [AOR] 1.45, 95% confidence interval [CI] 1.17-1.81), but barriers related to pain management beliefs were not (AOR 1.17, 95% CI 0.91-1.51). Attitudes/beliefs about acupuncture (i.e., greater expected benefits, fewer perceived barriers, and more positive social norms) and female gender also predicted acupuncture preference, whereas race and educational status did not.
Acupuncture may be a preferable treatment option among cancer patients at risk of inadequately controlled pain due to fear of analgesic side effects. Evidence-based integration of acupuncture and analgesics, guided by patient treatment preferences, represents an essential aspect of patient-centered care and has potential to address unmet cancer pain management needs.
全球约有一半的癌症患者疼痛治疗不足。阿片类药物和其他镇痛药是癌症疼痛管理的主要手段；然而，其使用的障碍已有充分的记录。我们评估了在对药物治疗疼痛持态度障碍的癌症患者中，针刺是否是一种更可取的治疗选择。
我们对美国东北部一家三级城市癌症中心和十一家郊区/农村医院的癌症患者进行了横断面调查。我们使用障碍问卷（BQ-13）评估了对药物治疗疼痛的态度障碍。BQ-13 由两个分量表组成：疼痛管理信念和镇痛副作用。我们还询问了患者他们是否更喜欢针刺、镇痛药，或者对这两种疼痛管理方式没有偏好。协变量包括社会人口统计学特征、临床特征以及对针刺的态度/信念。我们使用逻辑回归来检查态度障碍与针刺偏好之间的关联。
在 628 名患者中，197 名（31.4%）患者更喜欢针刺治疗疼痛，146 名（23.3%）更喜欢镇痛药，285 名（45.4%）没有偏好。报告的最高态度障碍是对成瘾的恐惧以及对镇痛相关便秘和恶心的恐惧。调整协变量后，我们发现与对镇痛副作用的恐惧相关的态度障碍与针刺偏好显著相关（调整后的优势比 [AOR] 1.45，95%置信区间 [CI] 1.17-1.81），但与疼痛管理信念相关的障碍则没有（AOR 1.17，95% CI 0.91-1.51）。对针刺的态度/信念（即，更高的预期益处、更少的感知障碍和更积极的社会规范）以及女性性别也预测了针刺偏好，而种族和教育程度则没有。
对于因担心镇痛副作用而可能导致疼痛控制不足的癌症患者，针刺可能是一种更可取的治疗选择。基于患者治疗偏好，将针刺与镇痛药相结合的循证整合是患者为中心的护理的一个重要方面，并有潜力解决未满足的癌症疼痛管理需求。
