Treatment of Moderate-to-Severe Pain in Hepatocellular Carcinoma with Transcutaneous Electrical Acupoint Stimulation: A Randomized Controlled Trial

Abstract

Objective

Moderate-to-severe pain is the most common clinical symptom in patients with hepatocellular carcinoma (HCC).This trial aimed to analyze the clinical efficacy of Transcutaneous electrical acupoint stimulation (TEAS) in patients of HCC with severe pain and provide a reliable reference for optimizing the clinical diagnostic and therapeutic strategies of HCC.

Methods

A total of 104 eligible patients were randomly allocated to experimental and control groups in a ratio of 1:1.The treatment was administered for 1 week continuously. Patients in both groups were followed up 1 week after the end of the treatment.The primary outcome measure was the Numerical Rating Scale (NRS) score, whereas the secondary outcome measures included Brief Pain Inventory BPI-Q3, Q4, Q5 scores, analgesic dose, frequency of opioid-induced gastrointestinal side effects, Karnofsky Performance Status (KPS), Quality of Life Scale - Liver Cancer (QOL-LC), and Brief Fatigue Inventory (BFI) scores.

Results

The NRS scores of experimental group was significantly lower after treatment and at the follow-up than baseline (average P<0.01), there were also statistical differences between the groups at the above time points (average P<0.01). BPI-Q3, -Q4, and -Q5 scores in the experimental group were decreased after treatment when compared with those before treatment (average P<0.01). Furthermore, there were significant improvements of gastrointestinal side effects, KPS, QOL-LC and BPI in the experimental group after treatment, and the above results were statistically significant compared to the control group.

Conclusion

7-day TEAS treatment can significantly enhance the analgesic effect and maintain for the following week, also reduce the incidence of gastrointestinal side effects caused by opioids, and improve the quality of life of patients with moderate-to-severe HCC-related pain, which has reliable safety and certain clinical promotion value.

Keywords:

• hepatocellular carcinoma pain
• transcutaneous electrical acupoint stimulation
• cancer pain
• randomized controlled trial

Data Sharing Statement

We all agree to share individual deidentified participant data. The data used to support the findings of this study are available from the corresponding author (Yan Huang) upon reasonable request in five years.

Consent for Publication

All the authors agreed to publish this article.

Acknowledgments

Lu Zhu, Jing Li and Zhao-Qin Wang are co-first authors for this study. The authors would like to thank 104 patients who agreed to participate in this trial. They also thank all the participants who conducted and assisted in this trial.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This study was supported by Shanghai 2020 “Science and Technology Innovation Action Plan” (20Y21902800); Qihuang scholar in the National Support Program for Leading Talents of Traditional Chinese Medicine; “Acupuncture and moxibustion Effect Mechanism and Clinical Efficacy Breakthrough” Project of Shanghai University Summit Discipline Construction (2021-2025); Shanghai Clinical Research Center for Acupuncture and Moxibustion (20MC1920500); High level Key Discipline of Traditional Chinese Medicine (Science of acupuncture and moxibustion) Construction Project of National Administration of Traditional Chinese Medicine (ZYYZDXK-2023068).