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Acupuncture
Acupuncture is a neurostimulatory technique that treats pain by the insertion of small, solid needles into the skin at varying depths, typically penetrating the underlying musculature. There are few controlled studies of its use; recent meta-analyses364 462 are inconclusive and do not specify which types of pain problems acupuncture can or cannot alleviate.
Pain can signal disease progression, the emergence of adventitious infection, or some significant complication of treatment. Therefore, patients who choose to have acupuncture for pain management should be encouraged to report new pain problems to their health care team before seeking palliation through acupuncture. Maintaining an open and accepting relationship will make it easier for the patient and the practitioner to discuss negative as well as positive experiences and situations where acupuncture might be contraindicated.
When a patient seeks TENS therapy or acupuncture, clinicians should listen for clues that would indicate that the pain is uncontrolled. If the patient is seeking these modalities because of poorly managed pain, the clinician, in cooperation with the patient, should revise the pain management plan by:
Correcting misconceptions the patient might have concerning the use of analgesic drugs, especially the phenomena of addiction and tolerance with opioids.
Escalating an analgesic dosage.
Adding an adjutant drug to manage a specific pain complaint or to counteract a side effect.
Prescribing a psychotropic drug to manage coexisting anxiety or depression.
Providing training in the use of cognitive-behavioral strategies.
Controlled studies are needed to test the effectiveness of counterstimulation in the treatment of cancer-related pain.
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