Effectiveness of acupuncture in managing aromatase inhibitor-related arthralgia in breast cancer: a systematic review and meta-analysis

Objective: Breast cancer is the second most prevalent cause of mortality in women and the predominant malignancy type. However, breast cancer treatment faces challenges in managing aromatase inhibitor-induced arthralgia. Aromatase inhibitors have been shown to decrease recurrence risk in hormone receptor-positive cases; however, joint discomfort remains the primary adverse effect. Randomized clinical trials have evaluated the therapeutic outcomes of acupuncture for medication-related musculoskeletal complications. This comprehensive analysis sought to elucidate both the therapeutic efficacy and placebo responses associated with acupuncture intervention. Methods: Two reviewers searched for randomized controlled trials (RCTs) in four English (PubMed, Embase, Web of Science, and the Cochrane Library) and four Chinese databases (CNKI, Wanfang Database, VIP, and SinoMed) from their inception to May 31, 2024. Methodological quality was assessed using the Cochrane risk of bias tool. Data were synthesized using random effects models and presented with forest plots. Results: Seven trials involving 604 patients were included. The primary outcome and Brief Pain Inventory (BPI) score differed between the acupuncture and control groups (sham acupuncture or usual medication) in three subscales over the course of 6 weeks: worst pain: standardized mean difference (SMD) = −1.18, 95% confidence interval (CI): −1.74, −0.63, P < 0.001; pain-related interference: SMD = −0.87, 95% CI: −1.70, −0.05, P = 0.038; pain severity: SMD = −0.63, 95% CI: −1.22, −0.04, P = 0.036. No severe adverse events were reported in any study. Conclusions: This meta-analysis showed that acupuncture is a safe and effective treatment for patients with breast cancer with aromatase inhibitor-induced arthralgia during the course of 6 weeks. Improvements in the blinding method and clarification of the total treatment recommendations and intervals need to be explored further.