Efficacy and Safety of Acupuncture Combined with Conventional Drug Therapy for the Treatment of Cancer-Induced Bone Pain: A Network Meta-Analysis of Randomized Controlled Trials.

Abstract

<h4>Background</h4>Cancer-induced bone pain (CIBP) involves both nociceptive and neuropathic components, causing significant suffering in cancer patients. Acupuncture has shown beneficial effects on CIBP. However, given the diverse acupuncture techniques, their therapeutic efficacy may vary.<h4>Objective</h4>To evaluate the efficacy and safety of various acupuncture modalities integrated with conventional drug therapy for CIBP.<h4>Methods</h4>Randomized controlled trials (RCTs) of acupuncture combined with conventional analgesics for CIBP were searched across eight Chinese and English databases and clinical trial registries up to September 2024. Two researchers independently performed literature screening, data extraction, and bias assessment. Data were analyzed using Stata 14.0 and R 4.2.3.<h4>Results</h4>Twenty-two RCTs involving 1,738 patients were included, assessing techniques including manual acupuncture (MA), electroacupuncture (EA), moxibustion (MOX), acupoint injection (AI), acupoint catgut embedding (ACE), auricular-plaster therapy (AP), thumbtack needle (TN) and transcutaneous electrical acupoint stimulation (TEAS). The outcomes were assessed across 20 studies for the clinical effective rate, 13 for nausea and vomiting, and 11 for constipation.The results indicated that for the primary outcome of pain relief (as measured by clinical effective rate), TN demonstrated the highest probability of being the most effective acupuncture technique (SUCRA = 75.2%). In terms of mitigating opioid-induced adverse reactions, ACE was most effective for reducing nausea and vomiting (SUCRA = 87.7%), while EA+AP was optimal for alleviating constipation (SUCRA = 93.5%). MA+MOX achieved the best overall balance between efficacy and the incidence of adverse reactions.<h4>Conclusion</h4>Acupuncture combined with conventional drug therapy significantly improves pain relief in CIBP and reduces opioid-related side effects. However, due to methodological limitations and the modest sample sizes of available studies, further high-quality, multicenter trials with larger samples are needed to confirm these findings and inform clinical practice.