Acupuncture vs. Massage for Insomnia and Pain in Advanced Cancer: Exploratory RCT.

Abstract

Insomnia symptoms affect over half of patients with advanced cancer and frequently co-occur with other conditions, particularly pain. Effective and well-tolerated treatments are needed. To compare acupuncture and massage therapy for insomnia symptoms with comorbid pain and examine the relationship between sleep and pain. Data were drawn from a multicenter pragmatic randomized clinical trial comparing acupuncture and massage therapy for pain in advanced cancer. Among 300 participants, 234 with baseline insomnia (ISI ≥8) were included. Participants received 10 weeks of treatment with follow-up through week 26. Insomnia symptoms were measured using the Insomnia Severity Index (ISI). Linear mixed-effects models evaluated longitudinal changes. Responder analyses defined ISI responders as those with an ≥8-point reduction or an ISI score <8 and pain responders as those with an ≥30% reduction in Brief Pain Inventory (BPI) severity at week 10. Both acupuncture and massage significantly improved ISI scores at week 10 (-3.86 and -3.83, respectively; both P < 0.0001), with no between-group difference (P = 0.91). ISI responder rates were similar (35.1% vs 33.3%), whereas BPI responder rates were higher (48.0% vs 62.9%). Pain responders had greater improvements in insomnia at week 10 (Δ = -2.97; P = 0.0003), although this association was attenuated by week 26. Insomnia responders showed greater reductions in pain at weeks 10 and 26 (both P < 0.0001). Acupuncture and massage improved insomnia in patients with advanced cancer. Sleep and pain showed a bidirectional relationship, supporting integrative approaches targeting symptom clusters.