Different Acupuncture Combined With Three-Step Analgesic Therapy in the Treatment of Bone Metastatic Cancer Pain: A Network Meta-Analysis Based on Randomized Controlled Trials.

Cancer pain (CP) is predominantly caused by bone metastases, imposing a significant burden on both patients and society. The limitations of the three-step analgesic (TSA) therapy in managing CP have become increasingly evident. Although acupuncture demonstrates promising therapeutic effects for this condition, there is currently limited research comparing the efficacy of different acupuncture modalities. A total of 20 studies were included, involving 1640 patients. The tumor types included lung cancer, prostate cancer, colorectal cancer, bile duct cancer, and breast cancer. A total of 9 acupuncture therapies were involved: acupoint embedding, auricular point pressing, electroacupuncture, ordinary acupuncture, bee therapy, fire needle therapy, moxibustion, acupoint injection, and acupoint application. The main outcome indicators were pain relief rate and NRS score, while the secondary outcome was the incidence of adverse reactions. The consistency test results showed no significant inconsistency among the comparison groups (p > 0.05), and a consistency model analysis was adopted. In terms of pain relief rate, electroacupuncture combined with auricular point pressing combined with the TSA therapy ranked the top three (SUCRA = 0.90), moxibustion combined with the TSA therapy ranked the top three (SUCRA = 0.84), and auricular point pressing combined with the TSA therapy ranked the top three (SUCRA = 0.65). In terms of reducing NRS scores, auricular point pressing combined with the TSA therapy ranked the top (SUCRA = 0.95), bee therapy combined with the TSA therapy ranked the top (SUCRA = 0.83), and acupuncture combined with acupoint injection combined with the TSA therapy ranked the top (SUCRA = 0.70). In terms of safety, the adverse reaction rate of fire needle therapy combined with the TSA therapy was the lowest (SUCRA = 0.98), electroacupuncture combined with auricular point pressing combined with the TSA therapy ranked the top (SUCRA = 0.81), and acupoint embedding combined with the TSA therapy ranked the top (SUCRA = 0.67). In terms of overall efficacy and safety, auricular point pressing combined with the TSA therapy performed the best in the benefit-risk assessment. Acupuncture combined with the TSA therapy can effectively relieve CP in bone metastasis, with fewer adverse reactions. The current evidence indicates that auricular point pressing combined with the TSA therapy is the best treatment option in terms of comprehensive benefits. Due to the limited number of included studies, low quality of evidence, and potential bias risks, the conclusion still needs to be further verified by high-quality research.