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Inhibitorji (zaviralci) aromataz (AI) zvišujejo stopnjo preživetja s popolno ozdravitvijo pri ženskah, ki so v menopavzi in imajo raka na dojkah hormonskega tipa (HR-pozitiven, kar pomeni, da imajo rakave celice receptorje za določene hormone, ti pa spodbujajo njihovo nadaljnjo rast, op.prev.). Polovica prej omenjenih žensk trpi za mišičnoskeletnimi bolečinami, ravno zato to pogosto vodi do prekinitve terapije, kar lahko negativno vpliva na zdrave celice in na splošno preživetje osebe z rakom na dojkah.
Zanimanje za akupunkturo je v porastu ravno zaradi skrbi glede rabe zdravil za lajšanje bolečin. Ta temeljijo na opiju, imajo močne stranske učinke in so izjemno zasvojljiva. Zato v Združenih državah številni centri za zdravljenje raka ponujajo dopolnilne terapije za lajšanje bolečin. Skoraj 90 % ameriških centrov za zdravljenje raka, osnovanih za Narodni inštitut za zdravljenje raka, priporoča pacientom, naj poskusijo akupunkturo. Pri tem jih jo samo 70 % priporoča za zdravljenje stranskih učinkov.
Dawn Hershman, onkolog na Columbia University Medical Centre v New York Cityu, se je odločil raziskati, ali bi akupunktura lahko pomagala pri lajšanju bolečin, ki jih povzročajo aromatazni inhibitorji - eno izmed najpogosteje rabljenih vrst zdravljenja za raka. Ta zdravila znižujejo raven estrogena in če se jih jemlje več kot pet ali deset let, hkrati zmanjšuje tveganje za ponovitev raka. Vendarle ta povzročajo tudi stranske učinke, še posebej bolečino, podobno artritisu. Posledica tega je, da skoraj polovica žensk zdravilo jemlje neredno ali pa ga popolnoma prenehajo jemati.
Raziskovalci v ZDA so na 11 univerzitetnih lokacijah izvedli randomiziran klinični poskus, v katerem je sodelovalo 226 postmenopavznih žensk, ki so prejemale AI za zgodnji stadij raka in so svoje bolečine ocenile s 3 na lestvici od 0 do 10. Vsaka je naključno prejela pravo akupunkturo, lažno akupunkturo (plitko zabadanje iglic na neakupunkturnih mestih) ali pa so bile na čakalni listi kot kontrolna skupina. Raziskovalci so akupunkturiste usposobili tako, da so vsi izvajali skladna zdravljenja. Obe akupunkturni skupini sta 6 tednov prejemali akupunkturo dvakrat tedensko, temu je sledilo 6 tednov zdravljenja z akupunkturo enkrat tedensko. Ženske so prosili, da beležijo svoje ravni bolečin.
Po 6 tednih zdravljenja, je bila najhujša bolečina v skupini s pravo akupunkturo za eno točko nižje na lestvici od 0 do 10 kot pri ostalih dveh skupinah. To je statistično pomemben učinek, ki je hkrati tudi večji kot je bilo opaženo pri alternativah, kot je duolextin, (antidepresiv, ki je rabljen za lajšanje bolečin pri ljudeh z rakavim obolenjem). Medtem se je delež sodelujočih, pri katerih se je raven bolečine zmanjšala za kar dve točki na lestvici (te je Hershman imenoval za ‘klinično pomenljive’ spremembe), skoraj dvakrat povečal; torej 30 % takšnih v obeh kontrolnih skupinah, medtem ko skoraj do 58 % takšnih v skupini s pravo akupunkturo. Za razliko od duolextina so pozitivni učinki ostali tudi po koncu zdravljenja z akupunkturo. Hershman je povzel, da je akupunktura ‘smiselna alternativa’ receptom zdravil, kot so duolextin in opiati, ki niso bili del te raziskave.
Rollin Gallagher, vodja raziskave strategij lajšanja bolečin na University of Pennsylvania v Filadelfiji, glavni urednik revije Pain Medicine, je poskus pozitivno sprejel. ‘To so temeljiti metodologi,’ je izjavil. ‘’Zdaj iz kliničnih poskusov izvirajo od blagi do dobri dokazi glede učinkovitosti akupunkture, in to je še en prispevek.’’
vir: https://jamanetwork.com/journals/jama/fullarticle/2687355
prevod: Tanja Topić
vir fotografij: online
Acupuncture for Joint Pain Associated with Aromatase Inhibitors for Breast Cancer
Aromatase inhibitors (AIs) increase disease-free survival in menopausal women with hormone–receptor-positive breast cancer, but half of such women experience AI-associated musculoskeletal pain that leads to discontinuation of therapy. Premature treatment discontinuation can negatively impact disease-free and overall breast cancer survival.
Interest in acupuncture has grown because of concerns over the use of opioid-based pain-relief drugs, which can have strong side effects and are extremely addictive. Many cancer centres in the United States therefore offer complementary therapies for pain relief. Almost 90% of US National Cancer Institute-designated cancer centres suggest that patients try acupuncture, and just over 70% offer it as a treatment for side effects.
Dawn Hershman, an oncologist at Columbia University Medical Centre in New York City, decided to investigate whether acupuncture could help to reduce the pain caused by aromatase inhibitors, one of the most commonly used treatments for breast cancer. These drugs lower oestrogen levels and, when taken over five to ten years, they reduce the risk that the cancer will recur. But they cause side effects, especially arthritis-like pain, which can cause up to half of women to take the medication irregularly, or to stop taking it altogether.
U.S. investigators at 11 academic sites conducted a Randomized Clinical Trial in which 226 postmenopausal women receiving an AI for early-stage breast cancer who reported pain scores of ≥3 (out of 10) were randomized to true acupuncture, sham acupuncture (shallow needling at non–acupuncture points), or waitlist control (no intervention). The researchers trained the acupuncturists to deliver consistent treatments. Both acupuncture groups received 6 weeks of biweekly acupuncture followed by 6 weeks of once-weekly sessions. The women were asked to record their pain levels.
After a six-week course of treatment, ‘worst pain’ in the true-acupuncture group was about one point lower on a scale from zero to ten than in either the sham or no-treatment groups. This is a statistically significant effect, and larger than is seen with alternatives such as duloxetine, an antidepressant used to help reduce pain in people with cancer. Meanwhile, the percentage of participants whose pain improved by at least two points (which Hershman describes as a “clinically meaningful” change) almost doubled, from around 30% in both control groups to 58% in the true-acupuncture group. Unlike with duloxetine, the benefits persisted after the acupuncture course had finished. Hershman concludes that acupuncture is a “reasonable alternative” to prescription medications such as duloxetine or opiates, neither of which were part of this study.
Rollin Gallagher, director of pain-policy research at the University of Pennsylvania in Philadelphia, and editor-in-chief of the journal Pain Medicine, welcomes the trial. “These are careful methodologists,” he says. “There is moderate to good evidence in clinical trials for acupuncture now, and this is another contribution.”
source: https://jamanetwork.com/journals/jama/fullarticle/2687355
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