Prospective study to assess fluid accumulation and tenosynovial changes in the aromatase inhibitor-induced musculoskeletal syndrome: 2-year follow-up data. A randomised trial of electro-acupuncture for arthralgia related to aromatase inhibitor use. A dual-center randomized controlled double blind trial assessing the effect of acupuncture in reducing musculoskeletal symptoms in breast cancer patients taking aromatase inhibitors Acupuncture for Treatment of Arthralgia Secondary to Aromatase Inhibitor Therapy in Women with Early Breast Cancer: Pilot Study Feasibility Trial of Electroacupuncture for Aromatase Inhibitor—Related Arthralgia in Breast Cancer Survivors Sham Acupuncture Devices – Practical Advice for Researchers A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain Predictors of aromatase inhibitor discontinuation as a result of treatment-emergent symptoms in early-stage breast cancer. A randomized trial assessing the use of electro-acupuncture for aromatase inhibitor-induced arthralgia. Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17. Randomized, blinded, placebo-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. Effects of electro-acupuncture on serum cytokine level and peripheral blood lymphocyte subpopulation at immune-related and non-immune-related points. Reliability and validity of a modified Brief Pain Inventory short form in patients with osteoarthritis. Pilot study of acupuncture for the treatment of joint symptoms related to adjuvant aromatase inhibitor therapy in postmenopausal breast cancer patients Prospective study to assess short-term intra-articular and tenosynovial changes in the aromatase inhibitor-associated arthralgia syndrome.
BACKGROUND Aromatase inhibitors ( AIs ) frequently lead to the AI-induced musculoskeletal syndrome ( AIMS S ) . Looking into its pathophysiology , 6 months of AI therapy thickens the tendon sheath with intra-articular fluid ( IAF ) retention and loss of grip strength . We here report 24-month follow-up data . PATIENTS AND METHODS A prospect i ve cohort study of 33 postmenopausal breast cancer patients received adjuvant endocrine therapy ; 27 received an AI and 6 received tamoxifen .  At baseline , 6 and 24 months patients had a rheumatologic examination , including a grip strength test , and magnetic resonance imaging of both h and s and wrists . The primary end point was tenosynovial changes ; secondary end points were changes in morning stiffness , grip strength and IAF . RESULTS Twenty-three AI and 5 tamoxifen patients completed all investigations . Between month 6 and 24 , IAF further increased in AI users ( P = 0.04 ) but not in tamoxifen users , and grip strength further decreased in both groups . The worsened tenosynovial changes were strongly correlated with a decrease in grip strength . At 24 months , morning stiffness continued to be present in over a third of AI users . CONCLUSION AIMS S represents a substantial problem in breast cancer patients . It is associated with tenosynovial changes , IAF retention , joint stiffness and loss of grip strength that do not improve with prolonged use BACKGROUND Arthralgia is a common and debilitating side-effect experienced by breast cancer patients receiving aromatase inhibitors ( AIs ) and often results in premature drug discontinuation . METHODS We conducted a r and omised controlled trial of electro-acupuncture ( EA ) as compared to waitlist control ( WLC ) and sham acupuncture ( SA ) in postmenopausal women with breast cancer who self-reported arthralgia attributable to AIs . Acupuncturists performed 10 EA/SA treatments over 8 weeks using a manualised protocol with 2 Hz electro-stimulation delivered by a TENS unit . Acupuncturists administered SA using Streitberger ( non-penetrating ) needles at non-traditional acupuncture points without electro-stimulation . The primary end-point was pain severity by Brief Pain Inventory ( BPI ) between EA and WLC at Week 8 ; durability of response at Week 12 and comparison of EA to SA were secondary aims . FINDINGS Of the 67 r and omly assigned patients , mean reduction in pain severity was greater in the EA group than in the WLC group at Week 8 ( -2.2 versus -0.2 , p=0.0004 ) and at Week 12 ( -2.4 versus -0.2 , p<0.0001 ) . Pain-related interference measured by BPI also improved in the EA group compared to the WLC group at both Week 8 ( -2.0 versus 0.2 , p=0.0006 ) and Week 12 ( -2.1 versus -0.1 , p=0.0034 ) . SA produced a magnitude of change in pain severity and pain-related interference at Week 8 ( -2.3 , -1.5 respectively ) and Week 12 ( -1.7 , -1.3 respectively ) similar to that of EA . Participants in both EA and SA groups reported few minor adverse events . INTERPRETATIONS Compared to usual care , EA produced clinical ly important and durable improvement in arthralgia related to AIs in breast cancer patients , and SA had a similar effect . Both EA and SA were safe Up to 50 % of women receiving aromatase inhibitor ( AI ) complain of AI-associated musculoskeletal symptoms ( AIMS S ) and 15 % discontinue treatment . We conducted a r and omized , sham-controlled trial to evaluate whether acupuncture improves AIMS S and to explore potential mechanisms . Postmenopausal women with early stage breast cancer , experiencing AIMS S were r and omized to eight weekly real or sham acupuncture sessions . We evaluated changes in the Health Assessment Question naire Disability Index ( HAQ-DI ) and pain visual analog scale ( VAS ) following the intervention compared to baseline . Serum estradiol , β-endorphin , and proinflammatory cytokine concentrations were measured pre and post-intervention . We enrolled 51 women of whom 47 were evaluable , including 23 r and omized to real and 24 to sham acupuncture . Baseline characteristics were balanced between groups with the exception of a higher HAQ-DI score in the real acupuncture group ( p = 0.047 ) . We did not observe a statistically significant difference in reduction of HAQ-DI ( p = 0.30 ) or VAS ( p = 0.31 ) between the two groups . Following eight weekly treatments , we observed a statistically significant reduction of IL-17 ( p ≤ 0.009 ) in both groups . No significant modulation was seen in estradiol , β-endorphin , or other proinflammatory cytokine concentrations in either group . We did not observe a significant difference in AIMS S changes between real and sham acupuncture . As sham acupuncture used in this study may not be equivalent to placebo , further studies with a non-acupuncture arm may be required to establish whether acupuncture is beneficial for the treatment of AIMS Background Aromatase inhibitors ( AIs ) are recommended as adjuvant hormone treatment for postmenopausal women with early breast cancer . A substantial proportion of women taking AIs experience joint pain and stiffness . Studies have suggested that acupuncture may be effective in treating joint pain . Objective A pilot study was conducted to evaluate the feasibility , safety and efficacy of using acupuncture to treat AI-induced arthralgia . Methods A total of 32 patients were r and omised to receive either sham or real electroacupuncture ( EA ) twice weekly for 6 weeks . Outcomes of joint pain , stiffness and physical function were measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , overall pain severity and interference with the BPI-SF and quality of life ( QOL ) with the Functional Assessment of Cancer Therapy-General ( FACT-G ) instrument . H and strength was assessed by a grip test , and a serum marker of inflammation ( C reactive protein ( CRP ) ) was also measured . All assessment s were performed at baseline , 6 weeks and 12 weeks , except for blood sample s at baseline and 6 weeks only . Results No serious adverse events were reported during or after acupuncture treatments . There were no significant differences in outcome measures . However , positive trends were observed in stiffness and physical function at week 12 in favour of real EA . Conclusions Findings suggest that acupuncture is feasible and safe in patients with breast cancer with joint pain caused by AI . A larger study with adequately powered to confirm these results and detect clinical ly relevant effects is needed Background . Arthralgia affects postmenopausal women receiving aromatase inhibitors ( AIs ) for breast cancer . Given the existing evidence for electroacupuncture ( EA ) for treatment of osteoarthritis in the general population , this study aims to establish the feasibility of study ing EA for treating AI-related arthralgia . Patients and Methods . Postmenopausal women with stage I-III breast cancer who reported AI-related arthral gia were enrolled in a single-arm feasibility trial . EA was provided twice a week for 2 weeks followed by 6 weekly treatments . The protocol was based on Chinese medicine diagnosis of “ Bi ” syndrome with electrostimulation of needles around the painful joint(s ) . Pain severity of the modified Brief Pain Inventory was used as the primary outcome . Joint stiffness , joint interference , and Patient Global Impression of Change ( PGIC ) were secondary outcomes . Paired t tests were used for analysis . Results . Twelve women were enrolled and all provided data for analysis . From baseline to the end of intervention , patients reported reduction in pain severity ( from 5.3 to 1.9 ) , stiffness ( from 6.9 to 2.4 ) , and joint symptom interference ( from 4.7 to 0.8 ) , all P < .001 ; 11/12 considered joint symptoms “ very much better ” based on the PGIC . Subjects also reported significant decrease in fatigue ( from 4.4 to 1.9 , P = .005 ) and anxiety ( from 7.1 to 4.8 , P = .01 ) . No infection or development or worsening of lymphedema was observed . Conclusion . Preliminary data establish the feasibility of recruitment and acceptance as well as promising preliminary safety and effectiveness . A r and omized controlled trial is warranted to establish the efficacy of EA for AI-related arthralgia in breast cancer survivors Several vali date d sham acupuncture devices have recently become available . While some debate exists on whether such needles are the best placebo control for an RCT of acupuncture , practical advice based on research experience is missing from the literature . This paper shares our concrete experience using the most commonly used such sham needle ( the ‘ Streitberger needle ’ and its paired verum needle ) in a large RCT ( n=135 ) which included a two-week run-in period . The placebo run-in gave us an opportunity to use the sham device on all participants , who were then re-r and omised to receive genuine acupuncture or to continue treatment with the device . The blinding was successful both at the end of the run-in and at the conclusion of the trial despite the re-r and omisation . We also report our experience with the sham needle in neuroimaging experiments where the magnetic machinery poses considerable challenges for acupuncture research BACKGROUND Tamoxifen , taken for five years , is the st and ard adjuvant treatment for postmenopausal women with primary , estrogen-receptor-positive breast cancer . Despite this treatment , however , some patients have a relapse . METHODS We conducted a double-blind , r and omized trial to test whether , after two to three years of tamoxifen therapy , switching to exemestane was more effective than continuing tamoxifen therapy for the remainder of the five years of treatment . The primary end point was disease-free survival . RESULTS Of the 4742 patients enrolled , 2362 were r and omly assigned to switch to exemestane , and 2380 to continue to receive tamoxifen .  After a median follow-up of 30.6 months , 449 first events ( local or metastatic recurrence , contralateral breast cancer , or death ) were reported--183 in the exemestane group and 266 in the tamoxifen group . The unadjusted hazard ratio in the exemestane group as compared with the tamoxifen group was 0.68 ( 95 percent confidence interval , 0.56 to 0.82 ; P<0.001 by the log-rank test ) , representing a 32 percent reduction in risk and corresponding to an absolute benefit in terms of disease-free survival of 4.7 percent ( 95 percent confidence interval , 2.6 to 6.8 ) at three years after r and omization . Overall survival was not significantly different in the two groups , with 93 deaths occurring in the exemestane group and 106 in the tamoxifen group . Severe toxic effects of exemestane were rare . Contralateral breast cancer occurred in 20 patients in the tamoxifen group and 9 in the exemestane group ( P=0.04 ) . CONCLUSIONS Exemestane therapy after two to three years of tamoxifen therapy significantly improved disease-free survival as compared with the st and ard five years of tamoxifen treatment PURPOSE Women with breast cancer ( BC ) treated with aromatase inhibitors ( AIs ) may experience joint symptoms that can lead to discontinuation of effective therapy . We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC . METHODS We conducted a r and omized , controlled , blinded study comparing true acupuncture ( TA ) versus sham acupuncture ( SA ) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs .  TA included full body/auricular acupuncture and joint-specific point prescriptions , whereas SA involved superficial needle insertion at nonacupoint locations . Outcome measures included the Brief Pain Inventory-Short Form ( BPI-SF ) , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and Modified Score for the Assessment of Chronic Rheumatoid Affections of the H and s ( M-SACRAH ) obtained at baseline and at 3 and 6 weeks . Results Of 51 women enrolled , 43 women were r and omly assigned and 38 were evaluable . Baseline characteristics were comparable between the two groups . Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks , which was lower for TA compared with SA ( 3.0 v 5.5 ; P < .001 ) . We also found differences between TA and SA in pain severity ( 2.6 v 4.5 ; P = .003 ) and pain-related interference ( 2.5 v 4.5 ; P = .002 ) at 6 weeks . Similar findings were seen for the WOMAC and M-SACRAH scores . The acupuncture intervention was well-tolerated . CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness , which was not seen with SA . Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect BACKGROUND In the adjuvant setting , tamoxifen is the established treatment for postmenopausal women with hormone-sensitive breast cancer . However , it is associated with several side-effects including endometrial cancer and thromboembolic disorders . We aim ed to compare the safety and efficacy outcomes of tamoxifen with those of anastrozole alone and the combination of anastrozole plus tamoxifen for 5 years . METHODS Participants were postmenopausal patients with invasive operable breast cancer who had completed primary therapy and were eligible to receive adjuvant hormonal therapy .  The primary endpoints were disease-free survival and occurrence of adverse events . Analysis for efficacy was by intention to treat . FINDINGS 9366 patients were recruited , of whom 3125 were r and omly assigned anastrozole  , 3116 tamoxifen , and 3125 combination . Median follow-up was 33.3 months . 7839 ( 84 % ) patients were known to be hormone-receptor-positive .  Disease-free survival at 3 years was 89.4 % on anastrozole and 87.4 % on tamoxifen ( hazard ratio 0.83 [ 95 % CI 0.71 - 0.96 ] , p=0.013 ) . Results with the combination were not significantly different from those with tamoxifen alone ( 87.2 % , 1.02 [ 0.89 - 1.18 ] , p=0.8 ) . The improvement in disease-free survival with anastrozole was seen in the subgroup of hormone-receptor-positive patients , but not the receptor-negative patients . Incidence of contralateral breast cancer was significantly lower with anastrozole than with tamoxifen ( odds ratio 0.42 [ 0.22 - 0.79 ] , p=0.007 ) . Anastrozole was significantly better tolerated than tamoxifen with respect to endometrial cancer ( p=0.02 ) , vaginal bleeding and discharge ( p<0.0001 for both ) , cerebrovascular events ( p=0.0006 ) , venous thromboembolic events ( p=0.0006 ) , and hot flushes ( p<0.0001 ) . Tamoxifen was significantly better tolerated than anastrozole with respect to musculoskeletal disorders and fractures ( p<0.0001 for both ) . INTERPRETATION Anastrozole is an effective and well tolerated endocrine option for the treatment of postmenopausal patients with hormone-sensitive early breast cancer . Longer follow-up is required before a final benefit : risk assessment can be made Abstract In a pooled analysis of four r and omized controlled trials of acupuncture in patients with migraine , tension‐type headache , chronic low back pain , and osteoarthritis of the knee we investigated the influence of expectations on clinical outcome . The 864 patients included in the analysis received either 12 sessions of  acupuncture or minimal ( i.e. sham ) acupuncture ( superficial needling of non‐acupuncture points ) over an 8 week period . Patients were asked at baseline whether they considered acupuncture to be an effective therapy in general and what they personally expected from the treatment . After three acupuncture sessions patients were asked how confident they were that they would benefit from the treatment strategy they were receiving . Patients were classified as responders if the respective main outcome measure improved by at least fifty percent . Both univariate and multivariate analyses adjusted for potential confounders ( such as condition , intervention group , age , sex , duration of complaints , etc . ) consistently showed a significant influence of attitudes and expectations on outcome . After completion of treatment , the odds ratio for response between patients considering acupuncture an effective or highly effective therapy and patients who were more sceptical was 1.67 ( 95 % confidence interval 1.20–2.32 ) . For personal expectations and confidence after the third session , odds ratios were 2.03 ( 1.26–3.26 ) and 2.35 ( 1.68–3.30 ) , respectively . Results from the 6‐month follow‐up were similar . In conclusion , in our trials a significant association was shown between better improvement and higher outcome expectations PURPOSE Aromatase inhibitors ( AIs ) are effective for treatment of hormone receptor-positive breast cancer , but adherence and persistence with therapy are poor . Predictors of treatment discontinuation are not clearly defined . It is unknown whether patients with intolerable toxicity from one AI are able to tolerate another . PATIENTS AND METHODS Women with early-stage breast cancer initiating AI therapy were enrolled onto a multicenter , prospect i ve , open-label r and omized trial of exemestane versus letrozole . Patients completed symptom question naires at baseline and serially during therapy . Patients who developed AI-associated intolerable symptoms and discontinued treatment were given the option to switch to the other study AI after a 2- to 8-week washout period . RESULTS Of the 503 enrolled women , 32.4 % discontinued initial AI therapy within 2 years because of adverse effects ; 24.3 % discontinued specifically because of musculoskeletal symptoms . Median time to treatment discontinuation as a result of any symptom was 6.1 months ( range , 0.1 to 21.2 months ) and was significantly shorter in patients r and omly assigned to exemestane ( hazard ratio [ HR ] , 1.5 ; 95 % CI , 1.1 to 2.1 ; P = .02 ) . Younger age and taxane-based chemotherapy were associated with higher likelihood of treatment discontinuation ( HR , 1.4 ; 95 % CI , 1.02 to 1.9 ; P = .04 ; and HR , 1.9 ; 95 % CI , 1.00 to 3.6 ; P = .048 , respectively ) . Of the 83 patients who chose to switch to the second AI , 38.6 % continued the alternate AI for a median of 13.7 months . CONCLUSION Premature discontinuation of initial AI therapy as a result of symptoms is common , although more than one third of patients may be able to tolerate a different AI medication . Additional research is needed to identify predictive tools and interventions for AI-associated treatment-emergent symptoms TPS120 Background : Arthralgia is one of the main side effects of aromatase inhibitor ( AI ) therapy and does not respond to conventional pain medication . It may occur in up to 50 % of women and lead to cessation of therapy and jeopardize their chance of cure . Acupuncture is currently used to treat a variety of conditions , including musculoskeletal pain . Crew et al published a trial which showed a benefit of acupuncture to treat AI induced joint symptoms . We commenced a feasibility study in 2009 to assess the use of acupuncture for AI induced arthralgia . We recruited 30 women and now have exp and ed this trial to assess efficacy . METHODS This prospect i ve controlled , double blinded r and omized study is recruiting women who are have early breast cancer and who have been taking a third generation AI for at least 6 months and are experiencing Brief Pain Inventory-Short Form ( BPI-SF ) score of ≥3 . They are r and omized to receive either real electro-acupuncture ( REA ) or sham electro-acupuncture ( SEA ) . The sham group receives sham acupuncture via specially design ed non-skin penetrating needles placed at points close to the real acupoints in the study . The acupuncture is administered twice weekly for 6 weeks . Surveys to assess pain , stiffness and physical function , inflammatory cytokines and clinical examination and grip strength are performed before , after completing 6 weeks of therapy and 6 weeks later . The primary objective is to compare the mean BPI-SF worst pain score at 6 weeks between the real and sham electro-acupuncture . 44 women are required to yield 80 % power to detect a reduction of ≥ 2 points on the BPI-SF worst pain item at a 5 % significance level , assuming a st and ard deviation of difference in score between treatment groups of 2.3 points . Paired t-tests will be used to compare pre and post values for each of the outcome measurements . In addition , two- sample t-tests will be used to compare the average change in score for the group r and omly assigned to receive electro-acupuncture with that for the group assigned to receive sham electro-acupuncture  . 34 of a planned 50 participants have been recruited . Reference : Crew et al. J Clin Oncol 28 : 1154 - 1160 , 2010 . Funded by Cancer Institute NSW Research Innovation Grant BACKGROUND Most recurrences in women with breast cancer receiving 5 years of adjuvant tamoxifen  occur after 5 years . The MA.17 trial , which was design ed to determine whether extended adjuvant therapy with the aromatase inhibitor letrozole after tamoxifen reduces the risk of such late recurrences , was stopped early after an interim analysis showed that letrozole improved disease-free survival . This report presents up date d findings from the trial . METHODS Postmenopausal women completing 5 years of tamoxifen treatment were r and omly assigned to a planned 5 years of letrozole ( n = 2593 ) or placebo ( n = 2594 ) . The primary endpoint was disease-free survival ( DFS ) ; secondary endpoints included distant disease-free survival , overall survival , incidence of contralateral tumors , and toxic effects . Survival was examined using Kaplan-Meier analysis and log-rank tests . Planned subgroup analyses included those by axillary lymph node status . All statistical tests were two-sided . RESULTS After a median follow-up of 30 months ( range = 1.5 - 61.4 months ) , women in the letrozole arm had statistically significantly better DFS and distant DFS than women in the placebo arm ( DFS : hazard ratio [ HR ] for recurrence or contralateral breast cancer = 0.58 , 95 % confidence interval [ CI ] = 0.45 to 0.76 ; P < .001 ; distant DFS : HR = 0.60 , 95 % CI = 0.43 to 0.84 ; P = .002 ) . Overall survival was the same in both arms ( HR for death from any cause = 0.82 , 95 % CI = 0.57 to 1.19 ; P = .3 ) . However , among lymph node-positive patients , overall survival was statistically significantly improved with letrozole ( HR = 0.61 , 95 % CI = 0.38 to 0.98 ; P = .04 ) . The incidence of contralateral breast cancer was lower in women receiving letrozole , but the difference was not statistically significant . Women receiving letrozole experienced more hormonally related side effects than those receiving placebo , but the incidences of bone fractures and cardiovascular events were the same . CONCLUSION Letrozole after tamoxifen is well-tolerated and improves both disease-free and distant disease-free survival but not overall survival , except in node-positive patients 571 Background : Aromatase inhibitors ( AIs ) have become the st and ard of care for the treatment of postmenopausal , hormone-sensitive breast cancer ( BC ) . However , patients receiving AIs may experience joint symptoms which can lead to early discontinuation of this effective therapy . We examined whether acupuncture improves AI-induced arthralgias in women with early stage BC . METHODS This study is a r and omized , single-blinded trial of true vs sham acupuncture twice weekly for 6 weeks in postmenopuasal women with early stage BC and self-reported musculoskeletal pain related to adjuvant AI therapy .  The active intervention included full body/auricular acupuncture and a joint-specific point prescription , whereas the sham arm involved superficial needle insertion at nonacupoint locations . Outcome measures included the Brief Pain Inventory-Short Form ( BPI-SF ) , Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC ) , and Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the H and s ( M-SACRAH ) obtained at baseline , 3 and 6 weeks . Lower scores reflect improvement in symptoms . RESULTS Of 43 women enrolled , 38 were evaluable at 6 weeks . Baseline characteristics were comparable between the groups . Median age : 57 ( 37 - 77 ) ; White/Hispanic/Black/Asian : 15/21/1/1 ; median body mass index ( kg/m2 ) : 29 ( 18 - 45 ) .  True acupuncture was associated with about a 50 % decrease in mean BPI-SF scores , whereas no change from baseline was observed for the sham acupuncture group ( see table ) . Similar findings were seen for the WOMAC and M-SACRAH pain , stiffness , and function scores ( P<0.05 ) . No adverse events were reported . CONCLUSIONS Women with AI-induced arthralgias treated with acupuncture had significant improvement of joint pain and stiffness , which was not seen with sham acupuncture . Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect . [ Table : see text ] No significant financial relationships to disclose The purpose of this study is to find out whether electro-acupuncture ( EA ) at acupoint LI.10 ( Shou San Li ) , which has not been considered as an immune-related point , has a similar immune effect as LI.11 ( Qu Chi ) . We recruited 24 male medical students for this study . They were r and omized into 3 groups : control group ( without acupuncture during the study period , n=7 ) , LI.11 group ( EA at LI.11 acupoint , n=9 ) and LI.10 group ( EA at LI.10 acupoint , n=8 ) . At the first day ( Day 1 ) , blood was taken from all subjects . But EA was applied to the LI.11 and LI.10 group immediately after blood drawing . On the second day ( Day 2 ) , EA was applied to the LI.11 and LI.10 group right before blood sample was taken . At the fourteenth day ( Day 14 ) , blood sample was taken for all subjects . The parameters of EA were 4 sec alternating intervals of 2 and 15 HZ ( dense and disperse ) and 1 - 4 mA in intensity for 20 min . The waveform of electrical impulse was bi-directional and pulse duration of 50 microsec . Blood analysis included flow cytometry for lymphocyte sub population s ( CD4 and CD8 positive cell percentages ) and ELISA for cytokines [ soluble interleukin-2 receptor ( sIL-2R ) , interferon (INF)-gamma , IL-4 , IL-6 , and IL-10 ] . We treated the result of Day 1 as a baseline value . After EA at acupoint LI.11 , CD4 positive cell percentage at Day 14 showed significant decrease compared to the baseline value ( p = 0.011 ) . CD8 positive cell percentage also decreased at Day 2 ( p = 0.038 ) and Day 14 ( p= 0.015 ) . In the LI.10 group , CD4 and CD8 levels at Day 14 were decreased significantly ( CD4 , p = 0.012 ; CD8 , p = 0.017 ) . Results of all cytokines concentrations of the LI.11 group did not change during the study period . But the serum level of sIL-2R of the LI.10 group at Day 14 was higher than the baseline value ( p = 0.018 ) . The serum level of IL-6 at Day 14 was lower than the baseline value ( p = 0.028 ) . The serum level of IL-4 at Day 2 was lower than the baseline value ( p = 0.025 ) . Our results showed that LI.11 and LI.10 acupoints cause a similar decrease of CD4 and CD8 population s. Increase of serum sIL-2R and decrease of serum IL-4 and IL-6 were observed when EA was applied at LI.10 acupoint , but not at LI.11 acupoint . In this study , we can underst and that EA may modulate the peripheral blood lymphocyte sub population s and serum cytokine levels of the immune system The Brief Pain Inventory short form ( BPI-sf ) is a vali date d , widely used , self-administered question naire developed to assess the severity of pain and the impact of pain on daily functions . A modified version was used daily in r and omised control trials of patients with arthritis undergoing treatment with cyclooxygenase-2 specific inhibitors and non-steroidal anti-inflammatory drugs .  Results indicate that the modified BPI-sf , much like the original scale , was internally reliable , consistent over time , and had good construct , as well as convergent and predictive validity in assessment of patients suffering from conditions of chronic pain . Each scale and individual pain intensity item refers to changes in osteoarthritis pain associated with medication use . The modified BPI-sf , like the parent scale , is a valid and reliable tool for situations in which pain is assessed daily and minimises the burden placed on patients to record information necessary for scientific investigations Introduction Aromatase inhibitors ( AIs ) have become the st and ard of care for the adjuvant treatment of postmenopausal , hormone-sensitive breast cancer . However , patients receiving AIs  may experience joint symptoms , which may lead to early discontinuation of this effective therapy . We hypothesize that acupuncture is a safe and effective treatment for AI-induced arthralgias . Methods Postmenopausal women with early-stage breast cancer who had self-reported musculoskeletal pain related to adjuvant AI therapy were r and omized in a crossover study to receive acupuncture twice weekly for 6 weeks followed by observation or vice-versa . The intervention included full body and auricular acupuncture , and a joint-specific point prescription . Outcome measures included the Brief Pain Inventory-Short Form ( BPI-SF ) , Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index , the Functional Assessment of Cancer Therapy-General ( FACT-G ) quality of life measure , and serum levels of inflammatory markers , IL-1β and TNF-α . Results Twenty-one women were enrolled and two discontinued early . From baseline to the end of treatment , patients reported improvement in the mean BPI-SF worst pain scores ( 5.3 to 3.3 , p = 0.01 ) , pain severity ( 3.7 to 2.5 , p = 0.02 ) , and pain-related functional interference ( 3.1 to 1.7 , p = 0.02 ) , as well as the WOMAC function subscale and FACT-G physical well-being ( p = 0.02 and 0.04 , respectively ) . No adverse events were reported . Discussion / conclusions In this pilot study , acupuncture reduced AI-related joint symptoms and improved functional ability and was well-tolerated . Implication s for cancer survivorsMusculoskeletal side effects are common among breast cancer survivors on adjuvant AI therapy , therefore , effective treatments are needed for symptom relief and to improve adherence to these life-saving medications PURPOSE Arthralgia is an adverse class effect of aromatase inhibitors ( AIs ) . To date , its exact mechanism remains unclear . The purpose of this study was to investigate the changes in clinical rheumatologic features and magnetic resonance  imaging ( MRI ) of h and s and wrists in AI and tamoxifen users . PATIENTS AND METHODS This is a prospect i ve single-center study including 17 consecutive postmenopausal patients with early breast cancer receiving either tamoxifen ( n = 5 ) or an AI ( n = 12 ) . At baseline and after 6 months , patients filled in a rheumatologic history question naire and a rheumatologic examination including a grip strength test was done . At the same time points , MRI of both h and s and wrists was performed . The primary end point was tenosynovial changes from baseline on MRI . Secondary end points were changes from baseline for morning stiffness , grip strength , and intra-articular fluid on MRI . Wilcoxon signed ranks was used to test changes from baseline and the Spearman correlation coefficient to assess the association between rheumatologic and MRI changes from baseline . RESULTS At 6 months , patients on AI had a decrease in grip strength ( P = .0049 ) and an increase in tenosynovial changes ( P = .0010 ) . The decrease in grip strength correlated well with the tenosynovial changes on MRI ( P = .0074 ) . Only minor changes were seen in patients on tamoxifen . AI users reported worsening of morning stiffness and showed an increase in intra-articular fluid on MRI . CONCLUSION The functional impairment of h and s in the AI-associated arthralgia syndrome is characterized by tenosynovial changes on MRI correlating with a significant decrease in h and grip strength
PURPOSE Acupuncture has been used as a complementary medical treatment for  arthralgia  and other types of pain .
The objective of this review is to assess the effectiveness of acupuncture in the treatment of  arthralgia in patients with breast cancer who were treated with aromatase inhibitors ( AIs ) .