Acupuncture and Moxibustion for Insomnia Relief in Cancer Patients

Potential Mechanisms

“According to Traditional Chinese Medicine, points are located along a network that connects different organ systems and parts of the body, and symptoms of disease arise when there are disruptions, deficiencies, or surges in these areas,” Dr Tian explained. “Acupuncture and moxibustion can alleviate these issues.”

She also cites increasing evidence from magnetic resonance imaging (MRI) studies indicating that acupuncture may “activate and regulate several brain regions related to sleep,” including the temporal lobe, prefrontal lobe, parietal lobule, anterior cingulate, precuneus, and supramarginal gyrus. In addition, findings suggest that acupuncture may help to regulate cerebral blood flow and neurotransmitter levels in the brain.⁶

Some evidence indicates “the fascia is involved, such that when the needles are inserted and twisted, the local fascia ‘grabs’ the needle, and this does not happen at sham sites,” adds Lorenzo G. Cohen, PhD, the Richard E. Haynes Distinguished Professor in Clinical Cancer Prevention and director of the Integrative Medicine Program at The University of Texas MD Anderson Cancer Center in Houston. ⁷ “As the fascia is all interconnected, this may be how the signals are transmitted to the brain.”

While there is scant data regarding the effects of acupuncture on insomnia specifically, Dr Cohen told Oncology Nurse Advisor that acupuncture may lead to less nighttime arousal via reduction in stress hormones including cortisol and norepinephrine. Acupuncture “has also been associated with modulation of melatonin and gamma-aminobutyric acid (GABA), both of which are associated with sleep onset and maintenance.” Additionally, acupuncture may influence factors such as pain, hot flashes, and anxiety that could contribute to insomnia.

Implications for Patient Care

Dr Cohen notes that evidence supporting acupuncture for the treatment of sleep disturbances in oncology is not currently as robust as the evidence regarding acupuncture for cancer-related pain or nausea, and he advises that patients first try gold-standard treatments for insomnia such as cognitive behavioral therapy for insomnia (CBT-I). ^8,9 “But there are few risks associated with acupuncture if provided by an appropriately trained therapist, and it is worth trying if other approaches are not working,” he said.

While acupuncture and moxibustion are appropriate for most patients, Dr Tian says timely intervention is key, as chronic cases are generally more challenging to treat. For this reason, clinicians should refer patients for an acupuncture evaluation as soon as symptoms become apparent.

She emphasized the need to refer patients to adequately trained practitioners with expertise in safely and effectively addressing cancer-related concerns. Licensure requirements vary across states, and a license or certification to practice acupuncture does not guarantee high-quality care or relevant experience.

Dr Tian further advised that clinicians refer to highly experienced practitioners with advanced training “to avoid serious side effects including infections, punctured organs, collapsed lungs, burns, needling of tumors, and injury to the central nervous system.” To that end, she recommends referring to providers who work full-time, have at least 10 years of clinical experience and advanced oncology training, and see 20 or more cancer-related patients per week.

Remaining Needs

Ongoing challenges in study of acupuncture and moxibustion include heterogeneity in the acupuncture points used, the frequency and duration of treatments, and other techniques used in combination with these interventions, according to Dr Tian. There is a need for high-quality research models and funding to accommodate these variables.

For now, as the “evidence remains mixed, better quality, larger, randomized clinical trials are needed before acupuncture can be considered the standard of care for insomnia in cancer, as it is now for pain and nausea,” Dr Cohen stated.

References

1. Wang CC, Han EY, Jenkins M, et al. The safety and efficacy of using moxibustion and or acupuncture for cancer-related insomnia: a systematic review and meta-analysis of randomised controlled trials. Published online January 10, 2022. Palliat Care Soc Pract. doi:10.1177/26323524211070569
2. Johns Hopkins Medicine. Acupuncture. Accessed August 15, 2022. https://www.hopkinsmedicine.org/health/wellness-and-prevention/acupuncture
3. Cleveland Clinic. Moxibustion: What Is It and Does It Work? Published February 9, 2022. Accessed August 15, 2022. https://health.clevelandclinic.org/moxibustion/
4. Garland SN, Xie SX, Li Q, Seluzicki C, Basal C, Mao JJ. Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial. Menopause. 2017;24(5):517-523. doi:10.1097/GME.0000000000000779
5. Wan Q, Luo S, Wang X, et al. Association of acupuncture and auricular acupressure with the improvement of sleep disturbances in cancer survivors: A systematic review and meta-analysis. Published online May 18, 2022. Front Oncol. doi:10.3389/fonc.2022.856093
6. Peng W, Hong X, Huangfu Y, et al. The cerebral mechanism of acupuncture for chronic insomnia with gastrointestinal disorder: protocol for a randomized controlled trial. Trials. 2021;22:386. doi:10.1186/s13063-021-05332-3
7. Bianco G. Fascial neuromodulation: an emerging concept linking acupuncture, fasciology, osteopathy and neuroscience. Eur J Transl Myol. 2019;29:8331. doi:10.4081/ejtm.2019.8331
8. Tack L, Lefebvre T, Blieck V, et al. Acupuncture as a complementary therapy for cancer care: Acceptability and preferences of patients and informal caregivers. J Acupunct Meridian Stud. 2021;14:67-74. doi:10.51507/j.jams.2021.14.2.67
9. Liou KT, Root JC, Garland SN, et al. Effects of acupuncture versus cognitive behavioral therapy on cognitive function in cancer survivors with insomnia: A secondary analysis of a randomized clinical trial. Cancer. 2020;126:3042-3052. doi:10.1002/cncr.32847