Acupuncture Combined with Three-Step Analgesic Drug Therapy for Treatment of Cancer Pain: A Systematic Review and Meta-Analysis of Randomised Clinical Trials

Table 1

Summary of randomised clinical studies of acupuncture combined with three-step analgesic drug therapy for the treatment of cancer pain.

Study (year)	Type of cancer	Sample sizes		Interventions		Acupuncture point selection	Session frequency and duration	Main outcomes and assessment of pain
		T	C	T	C
Wang (2018) [10]	Various	35	35	AT + C	Drug (three-step analgesic ladder)	LI4, LR3, and Ashi point	30 min qd 6 weeks	Response rate, NRS, and side effect rate
Wang (2016) [11]	Lung cancer	30	30	EA + C	Oxycodone sustained-release tablets	LI4, PC6, ST36, and SP6	30 min qd 14 days	Response rate, NRS, side effect rate, burst pain, onset time, and DOR
Zhong (2016) [12]	Various	30	30	FA + C	Morphine sulfate sustained-release tablets	Ashi point	Once a day 14 days	Response rate, QOL, and burst pain
Mi (2010) [13]	Gastric cancer	32	30	FN + AT + C	Drug (three-step analgesic ladder)	FN: BL21, BL18, and BL17. AT: CV12, ST25, and St36	30 min qod 4 weeks	Response rate and side effect rate
Bai (2019) [14]	Various	50	50	FN + C	Drug (three-step analgesic ladder)	Ashi point, ST36, and SP6	qod 14 days	Response rate, NRS, and side effect rate
Liu (2018) [15]	Various	72	75	TEAS + C	Drug (three-step analgesic ladder)	LI4, PC6, ST36, and SP6	30 min bid 3 weeks	Response rate, BPI-S, KPS, and side effect rate
Liu (2011) [16]	Liver cancer	30	30	AT + C	Tramadol hydrochloride sustained-release tablets	SP4, PC6, GB41, TE5, SI3, BL62, LU7, KI6, LR3, and LR14	qd 14 days	Response rate, NRS, QOL, side effect rate, onset time, and DOR
Fu (2019) [17]	Various	16/16	16	AT + C	Morphine hydrochloride sustained-release tablets	PC6 and SP6	1 h qd	Response rate, NRS, KPS, side effect rate, burst pain, onset time, and DOR
				WA + C
Wu (2019) [18]	Various	30	30	WA + C	Drug (three-step analgesic ladder)	Based on syndrome differentiation and disease differentiation	12 h qd 10 days	Response rate, VAS, burst pain, and side effect rate
Dong (2018) [19]	Various	60	60	WA + C	Drug (three-step analgesic ladder)	Based on syndrome differentiation and disease differentiation	10–12 h qd 7 days	Response rate, NRS, QLQ-C30, and side effect rate
Sun (2016) [20]	Various	30	30	AT + C	Oxycodone	LI4, PC6, ST36, SP6, Ashi point, and others	30 min qd 14 days	Response rate, NRS, KPS, QOL, and side effect rate
Zhang (2014) [21]	Various	30	30	AT + C	Drug (three-step analgesic ladder)	LI4 and ST36. Lung cancer: PC6 and LU6. Liver cancer: GB34, LR6, and LR3. Colorectal cancer: PC6, CV12, and TE6	30 min qd 7 days	Response rate, QOL, side effect rate, onset time, and DOR
Hui (2019) [22]	Various	40	40	AT + C	Drug (three-step analgesic ladder)	Ashi point, LI4, GV14, BL11, GB34, and LR3	30 min qd 14 days	Response rate, side effect rate, onset time, and DOR
Tan (2012) [23]	Various	106	101	AT + C	Drug (three-step analgesic ladder)	LI4 and PC6. Lung cancer: LU6. Liver cancer: GB34 and LR6. Colorectal cancer: CV12, ST36, and TE6	0.5–1 h qd 3 weeks	Response rate and side effect rate
Fan (2017) [24]	Lung cancer	35	34	AT + C	Drug (three-step analgesic ladder)	PC6, LI4, ST36, GB34, and SP6	20 min qd 20 days	Response rate, NRS, onset time, and DOR
Jiang (2016) [25]	Various	25	25	AT + C	Drug (three-step analgesic ladder)	Ashi point, LR3, and LI4	30 min qd 7 days	Response rate and NRS
Li (2017) [26]	Gastric cancer	30	30	AT + C	Drug (three-step analgesic ladder)	ST36, LR3, and LI4	30 min qd 7 days	Response rate, NRS, QOL, and side effect rate
Huang (2018) [27]	Various	31	31	AT + C	Drug (three-step analgesic ladder)	PC6. Lung cancer: LI4, LU4, LU6, and ST36. Liver cancer: GB34 and LR3. Breast cancer: LI4, STI8, and CV9. Gastric cancer: CV12, ST36, and TE6	30 min qd 7 days	Response rate
Peng (2012) [28]	Various	23	24	EA + C	Drug (three-step analgesic ladder)	LI4, PC6, ST36, and SP6	30 min qd 7 days	Response rate, onset time, and DOR

T: treatment group, C: control group, AT: acupuncture, EA: electroacupuncture, FA: floating acupuncture, FN: fire needle, WA: wrist-ankle acupuncture, DOR: duration of response, NRS: numerical rating scale, BPI-S: brief pain inventory-severity, QOL: quality of life, and KPS: Karnofsky performance status.