Acupuncture Reduces Pain After Breast Surgery

Based on strong trends emerging during the course of their ongoing clinical trial, the Duke researchers believe acupuncture is an effective antiemetic (a drug that reduces nausea and vomiting) that is less expensive and has fewer side effects than medications currently used.

"Up to 70 percent of women who undergo major breast surgery experience significant postoperative nausea and vomiting, so it is an important medical issue," said lead investigator and Duke anesthesiologist Dr. Tong Joo (T.J.) Gan.

"We've known from previous studies that acupuncture can be an effective antiemetic when compared to placebo, but it has never been tested against one of the most commonly used medications ondansetron (Zofran)," Gan continued. "Acupuncture turns out to be just as effective as the drug or better, and our patients also reported much less pain after surgery, a finding that surprised us."

Gan presented the results of his team's study today (Oct. 15) during the annual scientific sessions of the American Society of Anesthesiologists.

The study enrolled 40 women who were undergoing major breast surgery (breast augmentation, breast reduction or mastectomy) requiring general anesthesia. The procedures lasted between two and four hours, and most women were discharged after spending the night in the hospital.

Women were equally divided into three groups – one received acupuncture before the surgery, one received ondansetron prior to surgery and one received neither. They found that two hours following surgery, 23 percent of acupuncture patients reported nausea, compared to 36 percent for the drug and 69 percent for placebo. After 24 hours, 38 percent of acupuncture patients reported nausea, compared to 57 percent for the drug and 61 percent for placebo.

In regards to vomiting, 7 percent of acupuncture patients reported vomiting two hours following surgery, compared to 7 percent who received ondansetron and 23 percent who received the placebo. After 24 hours, 23 percent of acupuncture patients reported vomiting, compared to 28 percent for the drug and 46 percent for placebo.

"We were most surprised by the level of pain reported by women, with 31 percent of acupuncture patients reporting moderate to severe pain two hours after surgery, compared to 64 percent for ondansetron and 77 percent for placebo," Gan said.

Specifically, the researchers applied acupuncture at the sixth point along the pericardial meridian, which is located two inches below the bottom of the palm of the hand and between the two tendons connecting the lower arm with the wrist. According to Chinese healing practices, there are about 360 specific points along 14 different lines, or meridians, that course throughout the body just under the skin.

"The Chinese believe that our vital energy, known as chi, courses throughout the body along these meridians," Gan explained. "While healthiness is a state where the chi is in balance, unhealthiness arises from either too much or too little chi, or a blockage in the flow of the chi. By applying acupuncture to certain well-known points, the Chinese believe they can bring the chi back into balance."

For their study, the researchers used electroacupuncture, which uses an electrode – like that used in standard EKG tests – at the appropriate point. Instead of actually breaking the skin with the traditional long slender needles, the electroacupuncture device delivers a small electrical pulse through the skin.

"Electroacupuncture enhances or heightens the effects of traditional acupuncture," Gan explained. "In China, when acupuncture is used during surgery for pain relief, they commonly use electroacupuncture devices."

While it is not completely known why or how acupuncture – whether electroacupuncture or traditional – works, recent research seems to point to its ability to stimulate the release of hormones or the body's own painkillers, known as endorphins, Gan said.

"Ten years ago, a study involving acupuncture would not have been accepted at a scientific meeting like this," Gan said. "In many ways, the practices of the East are being accepted by the West, especially as we continue to learn why practices like acupuncture work."

The Duke trial will continue with a total of 75 patients, at which point the results will be used as the basis of an application to the National Institutes of Health for a larger clinical trial. The researchers also will look to combine acupuncture with antiemetics to see if this combination of Eastern and Western approaches has greater effectiveness.

The research was supported by Duke's department of anesthesiology. Duke colleagues Dr. Steve Parillo, Dr. Jennifer Fortney and Dr. Gregory Georgiade were part of Gan's research team.