"Complementary therapies, such as acupuncture, may help patients alleviate cancer-related pain.1 Notably, auricular acupuncture has been noted to help certain patients not only manage pain, but reduce their opioid use, according to Heather Jackson, PhD, FNP-BC, NEA-BC, FAANP.
“When we think about treating pain, if you’re going to treat the whole person you have to think about all the different aspects of the [individual],” Jackson explained, noting that complementary therapies are not panacea, but can be useful in addressing certain symptoms and treating the person in a holistic fashion.
“I said [to my patient], this could be 1 piece of the pie and then we can look at alternative medicines while we’re doing the acupuncture.”
In an interview with Oncology Nursing News®, Jackson, the administrative director of advanced practice for the Vanderbilt Ingram Cancer Center, discussed forms of therapy with acupuncture as well as her experience using acupuncture for a thyroid cancer survivor and how it helped him achieve his goal of coming off pain management treatment with an opioid.
Please discuss this patient’s diagnosis and the treatment that was chosen.
I had a wonderful case study that came to my clinic: a 49-year-old male who had a history of thyroid cancer, and did not have current active disease. He had completed his treatment, had surgery, and was still having a lot of facial pain [in the] left cheek, neck, and temporomandibular joint. He’d been taking oxycodone 15 mg 4 times [daily] and he came to me and said, ‘I’m a father, I’m a husband, and it’s really sedating for me, I can’t sit down at meals, I can’t enjoy social activities, anything I do is uncomfortable.’ He didn't have his full energy level.
We said: What can we do to try to get him off of the oxycodone, but still functioning and interacting with his family? I said, ‘how about acupuncture?’ and he was really interested in it. I looked at his medicine regimen and said ‘it’s not the cure-all, but it could be a piece of the pie.’
What did the conversation look like when you mentioned acupuncture and what questions did the patient have?
It’s very common where patients will say, ‘I don’t understand why we are doing this now?’
I go over the evidence with them and then I build their confidence by saying, ‘I’ve done research in this and it's safe enough that I’ve done stickers on babies all the way to needles in adult’s ears. I’ve had success in getting patients off of opioids and even reducing anxiety and depression.’
He and I looked through Google and some PubMed articles. I said feel free to look through them, read up on it, [and] bring whatever you want back… and that’s what he did. He was a very motivated patient, and he came back to me [in] clinic and said, ‘I did look through this and there is some justification to what you’re talking about. Let’s try it, what do I have to lose?’
What did acupuncture treatment look like for this patient?
The acupuncture that we do in our clinic is a modified acupuncture technique; it’s not full body, it’s limited to the ear. They call it auricular acupuncture, and [the] protocol that I use is called the battlefield protocol. Battlefield protocol was developed by the Air Force for pilots who couldn’t be on opioids long term; they couldn’t be on sedating medicines.2
The battlefield pain protocol is for pain treatment. They have studs that you can put in the ear and leave in—they’ll stay in the ear for up to 5 to 7 days.
I also have the NADA protocol which was developed for patients who were in detox programs, trying to do a methadone clinic, or [use] buprenorphine treat opioid use disorder. [Investigators] have seen that it helps with physiological symptoms as well as the psychological impact of being a dependent or having a use disorder.3
I talked to him about both options, the pain was the issue here, so I went to the battlefield protocol and said ‘we don't have to be so aggressive that I put studs, the needles in your ears that you walk around with, I could put some milder needles in your ear on the point, [and] you can rest for 20 to 30 minutes.
I usually turn the lights down in the exam room and I have a sound maker to try to help them relax; I step out of the room, let them relax with the needles in their ear, and then I come back and take the needles out. I offer acupressure stickers that are like a little band aid that I can put on a couple of little spots that way they can go home, they can be pressing on the area [to] give a little bit more stimulation.
I’ll tell the patient, you can come back anytime you want. There are no adverse risks except maybe a little bruising and bleeding which is quickly resolved, the needles are so small—they’re smaller than a needle you would even thread with. I will let them sort of direct [if they] want to come back in 2 weeks, in 4 weeks, [etc]. I recommend a few sessions that way [they] can build on top of each other. It doesn’t work for everyone, but if it does work you will notice different things, every patient is different.
Some patients will say ‘well, Heather I didn’t get 100% pain relief, which would be a pretty unattainable goal, but I did notice that I didn't have to take my medicine 3 times a day; I took it 2 times a day’ or ‘usually I can't sleep more than 6 hours [but] I slept 8 hours’ or ‘I could only walk in a mall for an hour and a half but I noticed after your treatments I’m able to walk for 2 hours.’
Those are the things I tell the patient you need to be looking for, I don’t expect a cure-all, but oftentimes they do complete their treatment and they’ll say ‘preprocedure I was an 8 out of 10 and now I’m a 6 or now I'm a 2 [for pain].’ That’s the conversation we usually have and what I tell the patient to be monitoring.
How did you measure this patient’s pain and how did he respond to the acupuncture treatment?
We looked at medicine doses because he wanted to be off oxycodone, and he had been so motivated to get off of the oxycodone that he had quit it cold turkey and had some reactions because his body was used to that for so many years. He realized [he] needed some help coming off of it, we talked about that. I said ‘let’s do the acupuncture and then gradually come down on the medicine, but it’s going to be a timed thing. It’s not going to happen overnight, we have to be patient, [and] you can’t push yourself too hard because we also don’t want the pain to flare up.’ That was how we walked through it, and he was amenable to that.
He did feel some pain relief right after the intervention and we ended up doing a series of 3 [treatments] for the actual acupuncture and he felt the pain was getting under control. Then we were able to reduce and completely wean him off the oxycodone, he was very motivated, within 4 months. He reported 100% relief of his right-side face pain and 50% relief on the left side after he had completed his treatments, and this would be reported to me in the follow-up when he came in 4 weeks later.
A big point that he shared with me was: ‘Heather, I can eat with my family, now I can go out to eat.’ He had young kids, middle school teenage [aged and] you can imagine the quality of life that was being impacted. He was so thrilled to be able to say now I can eat with my family.
[Today] he is not in my clinic anymore because we got him off of everything and he [only] needed help getting through that period of getting off the medicine. He’s not in our clinic anymore for cancer pain, but he’s under surveillance and should we need to intervene in the future we absolutely will.
Is there any monitoring or questions that you ask patients when they’re undergoing treatment?
You [may] have concerns [if] the patient has hemophilia, [which] some patients [do on] very rare occasions, or, if you have a patient with a pain condition—sometimes stimulation with a needle are not a good idea. It depends on what type of pain a person has.
If a person has a central sensitization, where there's pain everywhere the body, sometimes an event like a needle will trigger more pain. That’s something to be cautious with. You sort of have to interview with the patient, to get a gut feeling for the patient and know if this is going to be a good fit or not. Usually, the patients that are very motivated that have tried chiropractic or massage are open to other options— that’s a good indicator that this is probably going to be a successful treatment.
Otherwise, [concerns] would be very mild bleeding that can occur. If that does occur, [use] a cotton swab or a tissue, hold it on there and take it off.
I’ve never [seen] any bruising [with my patients]. Some patients don’t like the stickers that I’ve put on for acupressure, so we don’t use them if they don’t like them, but most people like them.
Do you have any clinical pearls to wrap up what you learned from this case study?
My advice would be to always consider [acupuncture] as an adjunct [therapy]. There’s a lot of miscommunication with complementary therapies and people will assume that’s the only option and that’s not what we’re saying when we say complementary, we say complementary [as] in addition to. We can all work together, we can all collaborate like we do multidisciplinary treatments for our patients, but this could be an option to add too."
References
Jackson HJ, Peal K. Auricular acupuncture for the treatment of cancer-related pain. Oncology Issues.2022;37(4):32-35. doi:10.1080/10463356.2022.2079353
Montgomery AD, Ottenbacher R. Battlefield acupuncture for chronic pain management in patients on long-term opioid therapy. Med Acupunct. 2020;32(1):38-44. doi:10.1089/acu.2019.1382
Carter K, Olshan-Perlmutter M. NADA protocol: integrative acupuncture in addictions. J Addict Nurs. 2015;26(1):52]. J Addict Nurs. 2014;25(4):182-287. doi:10.1097/JAN.0000000000000045
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