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Chinese Medicine and Cancer Care - Page 3

Acupuncture Analgesia

Since the early 1970s, neurophysiologist Bruce Pomeranz has studied the effectiveness of acupuncture on pain, nerve regeneration, and cutaneous wound healing. In 1976 Pomeranz used naloxone, an endorphin antagonist, to successfully block acupuncture analgesia, suggesting a physiological mechanism of action. He showed that acupuncture relieved chronic pain in 55% to 85% of patients, compared to a 30% relief of pain by placebo, demonstrating that acupuncture is as effective as many potent drugs.²⁰ Pomeranz comments, “It should be apparent that we know more about acupuncture analgesia than about many chemical drugs in routine use. For example, we know very little about the mechanisms of most anesthetic gases but still use them regularly.” Acupuncture analgesia is initiated by the stimulation of
small afferent sensory nerve fibers embedded in musculature that
send impulses to the spinal cord to affect the three centers: spinal
cord, midbrain, and hypothalamic-pituitary. When these centers
are activated, neurotransmitters release endorphins, enkephalins,
monoamines, and cortisol to block the pain messages.²¹ Increases
in serum β-endorphin, met-enkephalin and leu-enkephalin with
acupuncture have also been documented.²²

Needles placed near the pain site, either on an acupoint or at a tender spot (trigger point), activate segmental circuits to the spinal cord as well as all three centers. Local needling usually provides a more intensive analgesic effect than distal needling which activates the midbrain and pituitary without benefit to the local segmental circuit to the spinal cord. In practice, both local and distal needling enhances the overall analgesic effect. The Chinese experience with the use of acupuncture analgesia as
an adjunct or alternative to chemical anesthesia during surgery reveals that, in addition to effectively inhibiting the pain response, acupuncture also maintains normalized blood pressure, visceral reflexes (prevents collapse of the mediastinum and diaphragm and preserves gut motility), body temperature, while markedly reducing the risk of hemorrhage, accelerating wound repair, and shortening post-operative recovery time.²³

Because pain medications can cause nausea, constipation, and fatigue, as well as require escalating doses that place patients at risk for cardiopulmonary depression, hepatic or renal toxicity, acupuncture pain relief may prove to be of significant benefit.^24,25 In a study of 286 patients experiencing metastatic bone pain, use of an electroacupuncture apparatus resulted in 74% significant pain relief in addition to a much lower need for long-term narcotic analgesics.²⁶ In a randomized study of 48 gastric carcinoma patients receiving chemotherapy, acupuncture was
compared to pharmacological pain management with narcotics and nonsteroidal anti-inflammatory agents. Although immediate (12 hour) control was better with pharmacological therapy, after 2 months, long-term pain control was similar. Only in the acupuncture group was plasma leucine-enkephalin increased at 2 months, along with improvement in other side effects of chemotherapy and overall quality of life measures.²⁷
Acupuncture has also been reported to relieve the pain of herpes zoster, a typical chemotherapeutic side effect,²⁸ as well as aid in the regeneration of nerve tissue as evidenced by improved nerve conduction in patients suffering from peripheral neuropathy.²⁹ Both pain and edema were reduced in a study of 122 patients with late-onset edema due to radiation therapy.³⁰

Acupuncture for Nausea and Vomiting

There is reliable, compelling data for the effectiveness of acupuncture in relieving nausea and vomiting. The NIH Consensus Panel on Acupuncture in 1997 concluded, “there is clear evidence that needle acupuncture is efficacious for adult postoperative and chemotherapy nausea and vomiting.”³¹ A systematic review of randomized controlled trials showed consistent, positive results.³² Of 29 trials in which acupuncture was used when patients were awake, and not under anesthesia, 27 supported acupuncture. More than 2000 patients showed positive results in a review of the trials that were of the best methodological quality. A 1989 study by J.W. Dundee from Queen’s University in Belfast showed acupuncture to
significantly relieve post-operative nausea and vomiting: 78% of patients treated with acupuncture were free of sickness compared to 32% of the non-treated control group.³³ Dundee’s initial comparative studies examined the anti-emetic effect of the acupoint known as Pericardium 6 (Pc6 is located on the medial aspect of the arm above the wrist) in 105 patients with a history of nausea and vomiting in a previous round of chemotherapy. This study reported a 63% anti-emetic benefit from the acupuncture.^34-37 From 30-40% of women with early stage breast cancer still experience nausea and vomiting within 1 week of chemotherapy administration, even with the use of seratonin receptor antagonists.³⁸ Subsequent well-controlled studies have similarly shown acupressure or acupuncture applied to Pc6 provides a treatment benefit in 60-70% of patients compared to a 30% benefit with sham treatment.³⁹

Acupuncture Effects on Myelosuppression and Hormonal
Markers

In a study of 386 patients with medium and advanced-stage cancer with chemotherapy-induced leukocytopenia, acupuncture and moxibustion (heat produced by burning the herb Artemesia vulgaris on acupoints) increased the leukocyte count in 38% of the patients.⁴⁰ Among 48 patients with persistent leukopenia, stimulation of the acupoint known as Stomach 36, located laterally below the knee, led to an increased white blood cell count in more than 90% of those treated.⁴¹ In another study of 121 patients with leukopenia during radiation and chemotherapy, after 5 daily acupuncture and moxibustion treatments, white blood cell counts markedly increased.⁴²

The immune modulatory effects of acupuncture upon patients undergoing chemotherapy and radiation are summarized in a review article that shows an increase in peripheral blood counts of CD3+, CD4+ and natural killer (NK) cells, as well as an elevation in the CD4+/ CD8+ ratio. Macrophage activity is also increased by both acupuncture and moxibustion.⁴³ In a study of premenopausal women that compared normal subjects to those with benign mammary hyperplasia, measuring immune and hormonal markers, levels of CD8+ cells rose significantly after acupuncture, and the CD4+/ CD8+ ratio was reduced to match the control group. Serum E2 and Prolactin levels declined following acupuncture, while levels of follicle-stimulating hormone (FSH) increased. More than 50% of the women with hyperplasia had complete resolution of their nodules, while the others had a significant reduction.⁴⁴Women with climacteric symptoms due to chemotherapy-induced menopause or treatment with agents like tamoxifen experience hot flashes, night sweats, dry skin and vaginal dryness, and insomnia. Studies have indicated that acupuncture can help to control these symptoms in over
90% of the women treated.^45,46

MODERN CHINESE HERBAL RESEARCH

With the renaissance of traditional Chinese medicine in the 1950s, clinical researchers in China and Japan began searching for ways to improve outcomes for cancer patients undergoing chemotherapy and radiation. Over the last decades, this approach has become known as Fuzheng Gu Ben therapy, meaning to strengthen what is correct and secure the root. Fuzheng herbs support non-specific resistance and are known as biological response modifiers or adaptogens. In a monograph in 1981 on the use of fuzheng herbs with cancer patients, Tu Gouri commented, “the treatment of malignant tumors with combined methods of traditional Chinese medicine and western medicine has made much progress…patients with advanced malignant tumors usually have the symptoms of deficiency in qi and blood, deficiency of liver and kidney, and dysfunction of spleen and stomach. Tonics may improve the general condition and the immune function of the patients, enhance resistance against disease, and prolong their survival period. Furthermore, tonics also have protective effects against immune suppression, lowering of leukocyte count, suppression of bone marrow, and decrease of plasma
cortisol levels induced by radiotherapy and chemotherapy. All this benefits the treatment of malignant tumors.” ⁴⁷

Researchers from the University of California at San Francisco comment that Fuzheng therapy produces possible diverse biologic effects that include: “reduce the tumor load; prevent recurrence or formation of a new primary cancer; bolster the immune system; enhance the regulatory function of the endocrine system; protect the structure and function of internal organs and glands; strengthen the digestive system by improving
absorption and metabolism; protect bone marrow and hematopoeitic function; and prevent, control, and treat adverse side effects caused by conventional treatments for cancer.”⁴⁸ Excellent sources covering the role of Chinese herbs in cancer care may be found in Cancer and Natural Medicine and Natural Compounds in Cancer Therapy by John Boik⁴⁹ and the relevant monographs written by Subhuti Dharmananda, PhD, of the
Institute for Traditional Medicine in Portland, Oregon.⁵⁰

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January 2008
Volume 6, Number 1

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