Aromatase inhibitors (AIs) are commonly used in the management of hormone receptor–positive breast cancer in postmenopausal women. Joint pain and stiffness (arthralgia) are frequently reported adverse effects, with prevalence estimates ranging from approximately 20% to 70%, and these symptoms may affect daily function and adherence to therapy (Hyder et al., 2021; Niravath, 2013).
Acupuncture and electroacupuncture have been investigated as non-pharmacological approaches for managing these symptoms in randomised controlled trials (RCTs).
Randomised Controlled Trials
A multicentre randomised clinical trial involving 226 women with early-stage breast cancer and AI-related arthralgia compared electroacupuncture, sham acupuncture, and waitlist control over 8 weeks (Hershman et al., 2018). The electroacupuncture group showed greater reductions in pain severity compared to both sham and waitlist groups at the end of treatment. Differences were smaller at later follow-up points.
A randomised, sham-controlled trial evaluated acupuncture for AI-related joint symptoms and reported reductions in pain scores during the treatment period compared to sham intervention (Crew et al., 2010). The magnitude of effect varied across time points.
Another randomised controlled trial examined acupuncture for AI-associated musculoskeletal symptoms and reported changes in patient-reported outcomes, including pain and functional measures (Bao et al., 2014). Study design and sample size differed from larger trials.
Proposed Mechanisms
The mechanisms underlying aromatase inhibitor–related arthralgia are not fully understood. Proposed factors include reduced oestrogen levels, changes in inflammatory pathways, and altered pain sensitivity (Hyder et al., 2021).
Acupuncture has been studied for its potential effects on pain modulation. Experimental research suggests that it may influence endogenous opioid release, neurotransmitter activity, and central pain processing pathways (Zhao, 2008).
Electroacupuncture has also been associated in some studies with modulation of peripheral nerve activity and inflammatory responses. These mechanisms remain under investigation and do not directly establish clinical effectiveness for AI-related arthralgia.
Clinical Context
Randomised trials have examined acupuncture and electroacupuncture for AI-related arthralgia, with some studies reporting reductions in pain during the treatment period (Hershman et al., 2018; Crew et al., 2010).
Findings are not consistent across all studies, and differences between acupuncture and control groups may vary depending on study design, comparator, and follow-up duration. In some cases, effects appear to decrease after treatment has ended.
Management of AI-related arthralgia may include medication review, exercise-based interventions, and pharmacological symptom management. Acupuncture has been investigated as an adjunctive approach rather than a replacement for standard oncology care.
Consideration of acupuncture should be individualised and discussed within the treating oncology team.
References
Bao, T., Cai, L., Snyder, C., Betts, K., Tarpinian, K., Gould, J., et al. (2014). Patient-reported outcomes in women with aromatase inhibitor–associated arthralgia treated with acupuncture: A randomized controlled trial. Breast Cancer Research and Treatment, 144(3), 557–564. https://doi.org/10.1007/s10549-014-2896-z
Crew, K. D., Capodice, J. L., Greenlee, H., Brafman, L., Fuentes, D., Awad, D., et al. (2010). Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor–associated joint symptoms in women with early-stage breast cancer. Journal of Clinical Oncology, 28(7), 1154–1160. https://doi.org/10.1200/JCO.2009.23.4708
Hershman, D. L., Unger, J. M., Greenlee, H., Capodice, J. L., Lew, D. L., Darke, A. K., et al. (2018). Effect of acupuncture vs sham acupuncture or waitlist control on joint pain related to aromatase inhibitors among women with early-stage breast cancer: A randomized clinical trial. JAMA, 320(2), 167–176. https://doi.org/10.1001/jama.2018.8907
Hyder, T., Marino, C. C., Ahmad, S., Nasrazadani, A., & Brufsky, A. M. (2021). Aromatase inhibitor-associated musculoskeletal syndrome: Understanding mechanisms and management. Frontiers in Endocrinology, 12, 713700. https://doi.org/10.3389/fendo.2021.713700
Niravath, P. (2013). Aromatase inhibitor-induced arthralgia: A review. Annals of Oncology, 24(6), 1443–1449. https://doi.org/10.1093/annonc/mdt037
Zhao, Z. Q. (2008). Neural mechanism underlying acupuncture analgesia. Progress in Neurobiology, 85(4), 355–375. https://doi.org/10.1016/j.pneurobio.2008.05.004
Please note: This information is provided for educational purposes only and does not replace individual medical assessment.