Yang Mingxiao, Liou Kevin T, Garland Sheila N, Bao Ting, Hung Tony K W, Li Susan Q, Li Yuelin, Mao Jun J
Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA.
Department of Psychology and Discipline of Oncology, Memorial University, 232 Elizabeth Avenue, St. John's, NL A1B 3×9, Canada.
NPJ Breast Cancer. 2021 Nov 30;7(1):148. doi: 10.1038/s41523-021-00355-0.
Pain and insomnia often co-occur and impair the quality of life in cancer survivors. This study evaluated the effect of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on pain severity among cancer survivors with comorbid pain and insomnia. Using data from the CHOICE trial that compared acupuncture versus CBT-I for insomnia among cancer survivors, we analyzed the effect of interventions on pain outcomes in 70 patients with moderate to severe baseline pain. Interventions were delivered over eight weeks. We assessed average pain severity (primary outcome) and pain interference at baseline, week 8, and week 20. We further defined insomnia and pain responders as patients who achieved clinically meaningful improvement in insomnia and pain outcomes, respectively, at week 8. We found that compared with baseline, the between-group difference (-1.0, 95% CI -1.8 to -0.2) was statistically significant favoring acupuncture for reduced pain severity at week 8 (-1.4, 95% CI -2.0 to -0.8) relative to CBT-I (-0.4, 95% CI-1.0 to 0.2). Responder analysis showed that 1) with acupuncture, insomnia responders reported significantly greater pain reduction from baseline to week 4, compared with insomnia non-responders (-1.5, 95% CI -2.7 to -0.3); 2) with CBT-I, pain responders reported significantly greater insomnia reduction at week 8, compared with pain non-responders (-4.7, 95% CI -8.7 to -1.0). These findings suggest that among cancer survivors with comorbid pain and insomnia, acupuncture led to rapid pain reductions, which contributed to a decrease in insomnia, whereas CBT-I had a delayed effect on pain, possibly achieved by insomnia improvement.
疼痛和失眠常常同时出现，会损害癌症幸存者的生活质量。本研究评估了针刺疗法与失眠认知行为疗法（CBT-I）对同时患有疼痛和失眠的癌症幸存者疼痛严重程度的影响。利用比较针刺疗法与CBT-I治疗癌症幸存者失眠的CHOICE试验数据，我们分析了干预措施对70例基线疼痛为中度至重度患者疼痛结果的影响。干预措施为期八周。我们在基线、第8周和第20周评估了平均疼痛严重程度（主要结果）和疼痛干扰情况。我们进一步将失眠缓解者和疼痛缓解者分别定义为在第8周失眠和疼痛结果实现临床意义改善的患者。我们发现，与基线相比，组间差异（-1.0，95%CI -1.8至-0.2）具有统计学意义，表明在第8周针刺疗法在减轻疼痛严重程度方面优于CBT-I（-1.4，95%CI -2.0至-0.8），而CBT-I为（-0.4，95%CI -1.0至0.2）。缓解者分析表明：1）对于针刺疗法，失眠缓解者从基线到第4周的疼痛减轻程度显著大于失眠未缓解者（-1.5，95%CI -2.7至-0.3）；2）对于CBT-I，疼痛缓解者在第8周的失眠减轻程度显著大于疼痛未缓解者（-4.7，95%CI -8.7至-1.0）。这些发现表明，在同时患有疼痛和失眠的癌症幸存者中，针刺疗法能迅速减轻疼痛，这有助于减少失眠，而CBT-I对疼痛的影响具有延迟性，可能是通过改善失眠来实现的。
