Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors: The PEACE Randomized Clinical Trial.

The short version

This randomized clinical trial with 360 cancer survivors asked a practical question: for people who finished cancer treatment but still live with chronic musculoskeletal pain, does acupuncture work better than usual care — and which kind of acupuncture is better? The PEACE trial, run across six sites in New York and New Jersey and published in JAMA Oncology, compared electroacupuncture (electrical stimulation through needles placed in the body) with auricular acupuncture (needles placed at standardized points on the ear). Participants — mean age 62, about 70% women — had a prior cancer diagnosis, no current disease, and pain of at least three months. They were randomized to ten weekly sessions of electroacupuncture (145 people), ear acupuncture (143), or usual care (72), with pain scored on the Brief Pain Inventory, a 0-to-10 scale. Electroacupuncture points were tailored to where each person hurt, while ear acupuncture used the same standardized points for everyone — a deliberately pragmatic design reflecting how each style is really practiced. Nearly everyone (94.4%) completed the twelve-week assessment, unusually high retention for a pain trial in this population. Both acupuncture styles delivered real relief. Electroacupuncture reduced pain by 1.9 points more than usual care (97.5% CI 1.4–2.4, p<0.001 — roughly a one-third drop from the average starting pain of 5.2), and auricular acupuncture by 1.6 points more (97.5% CI 1.0–2.1, p<0.001). But ear acupuncture failed to prove itself as good as electroacupuncture, and it was harder to tolerate: 10.5% of ear-acupuncture patients stopped because of side effects — mostly ear discomfort — versus just 0.7% with electroacupuncture. For cancer survivors seeking alternatives to long-term pain medication, this trial makes electroacupuncture the stronger evidence-backed choice, with ear acupuncture as a workable fallback when body needling isn't practical. The design was pragmatic and the analysis blinded, though there was no sham-needle arm, so expectation effects can't be fully separated — and follow-up ended at 24 weeks, leaving durability an open question.

Key findings

• The PEACE trial randomized 360 cancer survivors with at least three months of musculoskeletal pain to electroacupuncture, auricular (ear) acupuncture, or usual care across six New York and New Jersey sites.
• Both acupuncture forms beat usual care after ten weekly sessions: electroacupuncture by 1.9 points and ear acupuncture by 1.6 points on the 0-10 Brief Pain Inventory (both p<0.001).
• Ear acupuncture could not demonstrate it was as effective as electroacupuncture, and one in ten ear-acupuncture patients stopped treatment because of side effects versus fewer than one in a hundred with electroacupuncture.
• The trial was designed with the opioid crisis in view, testing whether acupuncture can shoulder part of cancer-pain management without medication - the answer was yes for both forms.
• Adverse events were mild overall, making electroacupuncture the better-tolerated first choice and auricular acupuncture a fallback when body needling is impractical.

Common questions