# Acupuncture for aromatase-inhibitor joint pain

Source: https://onco.cc/technologies/acupuncture-aromatase-inhibitor-arthralgia/  
OnCo record `acupuncture-aromatase-inhibitor-arthralgia` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Joint pain and stiffness are the main reason women stop aromatase-inhibitor tablets early. In a large randomised trial, twelve weeks of acupuncture reduced that pain more than sham needling or no treatment, and the benefit lasted after the sessions ended.

## Summary

The SWOG S1200 trial (Hershman et al., JAMA 2018) randomised 226 postmenopausal women with early breast cancer and aromatase-inhibitor arthralgia to true acupuncture, sham acupuncture or waitlist control for six weeks twice weekly then six weekly maintenance sessions. At six weeks the mean worst-pain score fell by 2.05 points with true acupuncture versus 1.07 with sham and 0.99 with waitlist on a 0 to 10 scale; the difference against sham was statistically significant and persisted at 24 and 52 weeks. Adverse events were minor bruising. The 2022 SIO-ASCO pain guideline recommends acupuncture for aromatase-inhibitor-related joint pain, the only complementary therapy to receive a firm recommendation for a specific cancer-treatment pain syndrome. Whether it improves persistence with endocrine therapy, and therefore recurrence, has not been shown.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-10
- Tags: complementary; supportive-care; evidence:strong
- Principle: Needling at standard and joint-specific points modulates central pain processing and local inflammation; a sham-needle arm controls for expectation, and the true-acupuncture arm still outperformed it.
- Strengths: Multicentre randomised trial with a sham arm; Effect maintained a year after treatment; Firm SIO-ASCO 2022 recommendation
- Limitations: Access and cost of a course of sessions; Not yet shown to improve adherence to endocrine therapy; Effect size against sham is modest

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Acupuncture
- SWOG S1200: acupuncture for aromatase inhibitor-related joint pain (JAMA 2018): https://doi.org/10.1001/jama.2018.11350
- SIO-ASCO guideline: integrative medicine for pain management in oncology (JCO 2022): https://doi.org/10.1200/JCO.22.01357

## Connected records

- cancers: [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/)
- fronts: [Hormonal Therapy](https://onco.cc/fronts/hormonal/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Cancer pain management](https://onco.cc/technologies/pain-management/), [Endocrine therapy (SERMs, AIs, SERDs)](https://onco.cc/technologies/endocrine-therapy/), [Evidence-based integrative oncology](https://onco.cc/technologies/integrative-oncology/)
- drugs: [Exemestane](https://onco.cc/drugs/exemestane/), [Letrozole (and other aromatase inhibitors)](https://onco.cc/drugs/letrozole/)
- terms: [Aromatase inhibitor](https://onco.cc/terms/aromatase-inhibitor/), [Placebo](https://onco.cc/terms/placebo/)
- bottlenecks: [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline](https://onco.cc/key-papers/paper-mao-j-clin-oncol/)
- roadmaps: [Hormonal therapy roadmap: removing the ovaries → tamoxifen → oral degraders switched by a blood test](https://onco.cc/roadmaps/hormonal-therapy-roadmap/)

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