Tamoxifen, Letrozole and the other drugs in the Aromatase Inhibitor class are commonly prescribed long-term medications for women recovering from breast cancer. These drugs are often prescribed for many years, to help reduce the risk of recurrence.
When women are prescribed an Aromatase Inhibitor, their Naturopathic Doctor’s role is to help them feel well, while finishing their course of treatment. Fatigue and joint pain can both be alleviated with a comprehensive plan that includes acupuncture.
Although these drugs are effective at modifying hormones, they can come with a personal cost to the women who are using them, which may interfere with a woman’s willingness to stay on her treatment(1). AI (Aromatase Inhibitor) induced joint-pain is a common side effect, affecting up to 80% of women on long term therapy. AI induced joint pain causes women to discontinue their treatment more often than any other side effect, which prevents women from gaining the possible benefits of finishing their treatment(1–3).
It has been noted in the research that although so many women report side effects to their care providers, the majority of women are not offered solutions for this significant side effect.
Acupuncture is a non-invasive drug-free option that can help patients recover from their AI induced joint pain, while improving other side effects such as low mood and fatigue(4–8). Acupuncture has been used for multiple type of cancer-related pain, such as neuropathy from chemotherapy(9). Women who use Taxane-type chemotherapy before their AI treatment are at an even greater risk of joint pain, and benefit from regular acupuncture treatments in addition to their regular care(1). Acupuncture may reduce the need for stronger pain medications such as opioids, which can help patients feel more like themselves, rather than feeling sedated(10).
Breast cancer therapy is incredibly successful, but isn’t without personal cost to the patient. Fatigue and pain are common side effects of long-term aromatase inhibition. A total body approach, including assessing vitamin D should be a priority. Vitamin D deficiency increases the risk of AI induced joint pain.
In the studies on acupuncture for breast cancer, women see benefits such as improved pain and energy after mastectomy(5), and improved AI induced joint pain. Treatments are often administered 1-2 x per week by our Naturopathic Doctors or our Acupuncturist.
There are additional options for women experiencing AI induced joint pain, which most often affects the joints of the wrists and hands. Women who are vitamin D deficient may be more prone, so testing and treating your deficiency is an important part of a whole-body approach to the problem(11–13). Switching to a different AI may provide benefit, as does intentional exercise and yoga(3).
Returning to exercise and work are major goals of women recovering from breast cancer treatment. Feeling well enough to regain aspects of your life that were put on hold should be a priority. Focusing on movement and mood after treatment can also help reduce your risk of recurrence.
- Beckwée D, Leysen L, Meuwis K, Adriaenssens N. Prevalence of aromatase inhibitor-induced arthralgia in breast cancer: a systematic review and meta-analysis. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2017;25(5):1673–86.
- Chiu HY, Hsieh YJ, Tsai PS. Systematic review and meta-analysis of acupuncture to reduce cancer-related pain. Eur J Cancer Care (Engl). 2016 Feb 7;
- Yang GS, Kim HJ, Griffith KA, Zhu S, Dorsey SG, Renn CL. Interventions for the Treatment of Aromatase Inhibitor-Associated Arthralgia in Breast Cancer Survivors: A Systematic Review and Meta-analysis. Cancer Nurs. 2017 Aug;40(4):E26–41.
- Mao JJ, Xie SX, Farrar JT, Stricker CT, Bowman MA, Bruner D, et al. A randomised trial of electro-acupuncture for arthralgia related to aromatase inhibitor use. Eur J Cancer Oxf Engl 1990. 2014 Jan;50(2):267–76.
- Quinlan-Woodward J, Gode A, Dusek JA, Reinstein AS, Johnson JR, Sendelbach S. Assessing the Impact of Acupuncture on Pain, Nausea, Anxiety, and Coping in Women Undergoing a Mastectomy. Oncol Nurs Forum. 2016 01;43(6):725–32.
- Chen L, Lin C-C, Huang T-W, Kuan Y-C, Huang Y-H, Chen H-C, et al. Effect of acupuncture on aromatase inhibitor-induced arthralgia in patients with breast cancer: A meta-analysis of randomized controlled trials. Breast Edinb Scotl. 2017 Jun;33:132–8.
- Mao JJ, Farrar JT, Bruner D, Zee J, Bowman M, Seluzicki C, et al. Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: a randomized trial. Cancer. 2014 Dec 1;120(23):3744–51.
- Crew KD, Capodice JL, Greenlee H, Brafman L, Fuentes D, Awad D, et al. Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2010 Mar 1;28(7):1154–60.
- Donald GK, Tobin I, Stringer J. Evaluation of acupuncture in the management of chemotherapy-induced peripheral neuropathy. Acupunct Med J Br Med Acupunct Soc. 2011 Sep;29(3):230–3.
- Minchom A, Punwani R, Filshie J, Bhosle J, Nimako K, Myerson J, et al. A randomised study comparing the effectiveness of acupuncture or morphine versus the combination for the relief of dyspnoea in patients with advanced non-small cell lung cancer and mesothelioma. Eur J Cancer Oxf Engl 1990. 2016;61:102–10.
- Khan QJ, Reddy PS, Kimler BF, Sharma P, Baxa SE, O’Dea AP, et al. Effect of vitamin D supplementation on serum 25-hydroxy vitamin D levels, joint pain, and fatigue in women starting adjuvant letrozole treatment for breast cancer. Breast Cancer Res Treat. 2010 Jan;119(1):111–8.
- Prieto-Alhambra D, Javaid MK, Servitja S, Arden NK, Martinez-García M, Diez-Perez A, et al. Vitamin D threshold to prevent aromatase inhibitor-induced arthralgia: a prospective cohort study. Breast Cancer Res Treat. 2011 Feb;125(3):869–78.
- Rastelli AL, Taylor ME, Gao F, Armamento-Villareal R, Jamalabadi-Majidi S, Napoli N, et al. Vitamin D and aromatase inhibitor-induced musculoskeletal symptoms (AIMSS): a phase II, double-blind, placebo-controlled, randomized trial. Breast Cancer Res Treat. 2011 Aug;129(1):107–16.