Acupuncture can be an effective treatment for symptoms experienced by palliative care patients. It has been shown to reduce pain, nausea and vomiting, fatigue, and hot flashes through stimulating the release of endogenous opioids and modulating pain pathways. Acupuncture is also very safe when administered properly. Systematic reviews of clinical trials have demonstrated its efficacy for several symptoms common in palliative cancer care. Integrating acupuncture into conventional care early on can improve symptom management for palliative patients.

1. ACUPUNCTURE
IN PALLIATIVE CARE
EVIDENCE BASED MEDICINE
Sara Bowling, MD
Family Medicine and Medical Acupuncture
Family Care Network

2. INTEGRATIVE MEDICINE

3. CONVENTIONAL CARE

4. Symptom A
Symptom D
Symptom C
Symptom B

5. THE PILL BURDEN
Average elderly patient is on 8-13 medications

6. Anorexia
Anxiety
Constipation
Delirium
Depression
Diarrhea
SYMPTOMS IN END OF LIFE
Dyspnea
Fatigue
Nausea andVomiting
Pain
Respiratory tract secretions

7. Dexamethasone
Diazepam and Lorazepam
Docusate and Senna
Haloperidol
Amitriptyline and
Fluoxetine
WORLD HEALTH ORGANIZATION
ESSENTIAL MEDICATIONS LIST FOR PALLIATIVE CARE
Loperamide
Morphine
Metoclopramide
Ibuprofen
Hyoscine butyl-bromide

8. Dexamethasone - A
Diazepam/ Lorazepam- D
Docusate and Senna-D
Haloperidol - A
Amitriptyline and
Fluoxetine
EVIDENCE BEHIND MEDICATIONS
Loperamide - D
Morphine - A
Metoclopramide
Ibuprofen
Hyoscine butyl-bromide

9. SIDE EFFECTS
Dexamethasone
Anaphylactic reactions, acute
myopathy, perineal irritation,
psychiatric disturbances
Haloperidol
QT prolongation, anticholinergic
effects, leukopenia, CNS depression,
extrapyramidal symptoms, esophageal
dysmotility, orthostatic hypotension
Morphine
Constipation, CNS
depression, hypotension,
hypersensitivity reaction,
respiratory depression

10. ACUPUNCTURE
SAFE & EFFECTIVE

11. ACUPUNCTURE
IS SAFE
Rare Adverse Events
Dizziness
Subcutaneous bleeding
Mild burn

12. ACUPUNCTURE IS SAFE
Special Considerations
Never placed in tumor or ulcerated area
Never placed in limbs prone to lymphedema
Care when treating over chest wall in cachectic patients
No electroacupuncture if pacemaker

13. IS ACUPUNCTURE PAINFUL?

14. WHAT IS
ACUPUNCTURE?
Originated 2000 years ago
North America in the 1970s
as useful for anesthesia
A series of meridians through
which energy flows

15. THE SCIENCE OF ACUPUNCTURE?

17. PAIN MODULATION

18. ENDOGENOUS OPIOIDS
Stimulates release of dynorphin,
enkephalin, beta-endorphin.
Increases endogenous
cannabinoid receptors
Up-regulates opioids in inflamed
tissues

19. ENDOGENOUS OPIOIDS
Opioid antagonists such as naloxone, can reverse the analgesic
effects of acupuncture.

20. NATIONAL INSTITUTE OF HEALTH
CONSENSUS STATEMENT, 1997
“Acupuncture is an effective treatment modality for adult
postoperative and chemotherapy nausea and vomiting.”
“There is sufficient evidence of acupuncture’s value to
expand its use into conventional medicine and encourage
further studies of its physiology and clinical value”

21. ACUPUNCTURE IS
EVIDENCE BASED MEDICINE
Research / DataClinical Expertise
PatientValues
& Expectations

22. The challenges of the acupuncture control:
SHAM acupuncture

23. SYSTEMATIC REVIEWS
Fatigue*
Nausea-Vomiting**
Pain*
Hot flashes*
Xerostomia
Dyspnea
Anxiety
Anorexia
Constipation
Paresthesia
Insomnia
Limb edema

24. WHO’S 3- STEP LADDER FOR
CANCER PAIN RELIEF

25. PAIN

26. PAIN

27. NAUSE ANDVOMITING

28. FATIGUE

29. HOT FLASHES

30. INTEGRATIVE
EVIDENCE BASED MEDICINE
Research / DataClinical Expertise
PatientValues
& Expectations

31. Acupuncture is effective for
Pain control
Nausea and vomiting
Fatigue
Hot flashes
It is best used alongside conventional medicine early on
in treatment, rather than as last resort

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