| ObjectiveCancer pain is a common accompanying symptom in cancer patients and is characterized by complexity,diversity,and individual differences,seriously affecting patients’ quality of life.Acupuncture is an advantageous therapy in Traditional Chinese Medicine,and clinical practice has shown that acupuncture has a good therapeutic effect on pain.This article explores the basic conditions for carrying out acupuncture treatment for cancer pain in Singapore,the challenges faced,and proposes systematic and scientific methods and strategies through the following research work.Firstly,the history and current status of acupuncture treatment in Singapore are systematically analyzed,clarifying the role of acupuncture in the Singapore medical system and its awareness and acceptance in the community.The disease spectrum of acupuncture treatment is summarized.Secondly,the latest achievements in acupuncture treatment for cancer pain are summarized,and successful experiences in acupuncture treatment for cancer pain in other countries and regions are referenced to provide a basis for Singapore to carry out research on acupuncture treatment for cancer pain.Finally,targeted development strategies and recommendations are proposed to promote the application and development of acupuncture treatment for cancer pain in Singapore and provide effective pain management programs for cancer patients.MethodsA systematic study of literature on modern medicine and Traditional Chinese Medicine for cancer pain was conducted to clarify the etiology and pathogenesis of cancer pain and analyze the main problems in clinical treatment of cancer pain in modern medicine and Traditional Chinese Medicine respectively.Theoretical methods to improve the effectiveness and reliability of clinical acupuncture treatment for cancer pain were explored.The evidence-based acupuncture system established by Professor 许能贵’s team was summarized to investigate the scientific methods for conducting clinical research on modern acupuncture treatment for cancer pain.A meta-analysis approach is used to summarize the latest clinical trial results of acupuncture treatment for cancer pain.Literature selected includes randomized controlled trial research reports on acupuncture treatment for cancer pain published within the last ten years,obtained from 8 literature databases:China Biomedical Literature Database(CBM),VIP Database for Chinese Technical Periodicals(VIP),China National Knowledge Infrastructure(CNKI),WANFANG Database,Cochrane Library,PubMed,Embase,and Web of Science.According to the meta-analysis requirements,the main criteria for inclusion are:clinical trial design using randomized controlled trial methods,trial sample size not less than 30,acupuncture as the primary intervention,and pain relief as the primary clinical observation index.Animal studies,case reports,qualitative research,descriptive surveys,and literature reports provided in abstract form only are excluded.Two researchers independently review and extract data from the literature based on inclusion criteria.Differences in opinion are resolved through discussion and consensus.The Cochrane Collaboration’s risk of bias assessment tool is used for literature quality assessment,evaluating each included study report.Data analysis is performed using RevMan 5.4 software provided by the Cochrane Collaboration.Reviewing the history of Traditional Chinese Medicine development in Singapore and systematically analyzing the important factors that affect the development of Traditional Chinese Medicine research in Singapore.Through analyzing the number of outpatient visits and patient structure surveys in recent years,insight into the status of the Traditional Chinese Medicine market in Singapore was gained.Based on this,further research was conducted to analyze the disease spectrum of acupuncture treatment and to understand the current clinical application of acupuncture in Singapore.In-depth analysis was carried out to identify the various conditions and challenges involved in conducting acupuncture treatment for cancer pain research in Singapore.Strategies and recommendations were proposed for conducting acupuncture treatment for cancer pain research in Singapore.ResultsIn-depth literature research has found that there are different characteristics in the treatment of cancer pain in Western and Traditional Chinese Medicine.Modern medicine mainly uses drugs to alleviate pain in cancer pain treatment,such as analgesics,antiinflammatory drugs,etc.In clinical practice,the three-step analgesic treatment plan proposed by the World Health Organization is widely used.The advantages of modern medical treatment of cancer pain are that analgesic drugs can quickly and effectively relieve patient pain and improve their quality of life.The disadvantages are that opioid drugs inevitably cause addiction and resistance,and long-term use can cause various adverse reactions in the body.Traditional Chinese Medicine believes that cancer pain is caused by factors such as"qi stagnation and blood stasis."Therefore,the treatment plan for cancer pain in Traditional Chinese Medicine is mainly through regulating qi and blood to alleviate pain,using different methods such as Chinese herbal medicine,acupuncture,and massage.Acupuncture is a safe and effective pain management method with a long history.Acupuncture stimulates specific points on the body to promote blood flow and alleviate pain.Combining Traditional Chinese Medicine with Western Medicine in the treatment of cancer pain can leverage the advantages of both methods,resulting in better pain relief and fewer side effects.The effectiveness of acupuncture treatment in clinical settings may vary due to factors such as the acupuncturist’s experience,needle selection,choice of acupuncture points,needling techniques,and patients’ cultural and educational backgrounds.To promote the widespread use of acupuncture as a pain management method,modern acupuncture based on the theory of evidence-based medicine is the way forward.The team led by Professor Xu Nenggui has developed evidence-based acupuncture medicine,which inherits and innovates Traditional Chinese Medicine theory,guides clinical practice,and collects data from clinical practice to conduct modern basic research,discover and verify the mechanisms of acupuncture treatment.This approach can guide more extensive clinical practices,facilitate the clinical-industrial transformation of acupuncture,and promote the development of acupuncture worldwide.This evidence-based approach to acupuncture research has a positive guiding role in promoting the research and development of acupuncture and Traditional Chinese Medicine in SingaporeUsing the meta-analysis method to study the results of 19 relevant randomized controlled trials on acupuncture treatment for cancer pain,the results show that the combined analgesic effect of acupuncture and medication is superior to the analgesic effect of medication alone(n=676,P=0.02,I2=55%,-1.12[-1.37,-0.87]);acupuncture treatment can significantly improve the quality of life of patients(n=250,P=0.11,0.77[0.51,1.03]);and acupuncture treatment can effectively reduce adverse reactions(n=349,P=0.61,-0.45[-0.53,-0.37]).However,some of the literature did not clearly describe whether allocation concealment was used,and whether blinding was employed in the collection of clinical results.This suggests that the quality of experimental design still needs to be improved and enhanced.To achieve higher levels of research results,attention should be paid to the following aspects.First,improve the design of clinical trial protocols,conduct studies in collaboration with different hospitals,increase the sample size to reduce sample errors.Second,strictly adopt blinding methods to reduce experimental bias and better meet the requirements of evidence-based medicine trials.Third,standardize acupuncture treatment plans and acupuncture prescriptions to ensure clinical trial safety and control.Fourth,standardize clinical efficacy observation indicators to facilitate data collection for statistical analysis.In addition,including the decline in quality of life and psychological disorders caused by cancer pain in comprehensive clinical indicators is practically significant for improving efficacy judgments.Finally,record various changes and adverse reactions during the trial process in detail and in real-time and perfect the trial report.Traditional Chinese Medicine has a long history in Singapore.In a country with strict policies and laws like Singapore,the development of Traditional Chinese Medicine cannot be separated from policy and regulatory support.In 1994,the government established a specialized management agency for Traditional Chinese Medicine-the Singapore Traditional Chinese Medicine Practitioners Board,and began implementing a registration management system for Traditional Chinese Medicine practitioners and acupuncturists in 2000.Traditional Chinese Medicine in Singapore entered a new stage of standardization and rapid development,serving society through outpatient services.This article investigates the situation of acupuncture treatment in Traditional Chinese Medicine outpatient clinics in Singapore and finds that acupuncture treatment is relatively common in various Traditional Chinese Medicine clinics,with a wide range of diseases treated by acupuncture.Statistics and analysis were conducted on the outpatient visits of the famous Traditional Chinese Medicine institution in Singapore,the Singapore Chung Hwa Medical Institution,from 2017 to 2021.The changes in outpatient visits were longitudinally compared,and the factors such as age,gender,education level,race,and nationality were analyzed for their impact on the changes in outpatient visits.The results showed that the acceptance of Traditional Chinese Medicine and acupuncture by the Singapore community was generally stable.By analyzing the changes in the number of visits to the Traditional Chinese Medicine oncology outpatient clinic and the acupuncture outpatient clinic,it can be seen that although there was no statistically significant change in the number of visits to the Traditional Chinese Medicine oncology clinic,the actual number of patients seeking treatment is gradually increasing,which is consistent with the global trend in cancer epidemiology.Therefore,there is a practical clinical demand for conducting acupuncture treatment research on cancer pain in Singapore.Since 2014,the Ministry of Health in Singapore has been funding research on Traditional Chinese Medicine.By 2021,a total of 20 research projects had been funded.Among them,10 projects were related to acupuncture,and 6 of them proposed to conduct research using randomized controlled trial designs,highlighting the importance attached by the Singaporean TCM community to research on evidence-based acupuncture.ConclusionLiterature review has shown that the combined treatment of cancer pain using both Traditional Chinese Medicine and Western Medicine can leverage the respective strengths of both medical systems,achieving better pain relief.A meta-analysis of randomized controlled trials in the past decade on combined acupuncture and medication treatment for cancer pain indicates that this approach is safe and effective,providing significant pain relief for various types of cancer pain,reducing the adverse reactions caused by medications,and improving patients’ quality of life.Singapore has an advanced Western medical system and a stable Traditional Chinese Medicine system,making acupuncture treatment for cancer pain feasible in the country.Facing an increasing number of cancer pain patients in clinical settings,it is of practical significance to conduct systematic research on acupuncture treatment for cancer pain.The Singapore government’s strict policies and regulations have a significant impact on the development of Traditional Chinese Medicine.In recent years,the government has introduced a series of policy measures to manage,support,and promote the development of Traditional Chinese Medicine in Singapore,providing policy support for clinical and evidence-based medicine research in acupuncture and Traditional Chinese Medicine.Given that the study of acupuncture in Singapore is in its initial stage,the academic achievements of Professor Xu Nenggui’s team can be referenced.Clinical randomized controlled trials should be conducted strictly following evidence-based medicine approaches,using modern basic research techniques and methods to explore the theories and mechanisms of acupuncture treatment for cancer pain,and form a complete evidencebased medicine evidence chain,promoting the scientific and standardized clinical research of acupuncture treatment for cancer pain.In the context of Singapore’s multi-ethnic and multicultural social environment,the research findings can serve as a good demonstration for other non-Chinese cultural regions in the world,promoting the internationalization of acupuncture treatment for cancer pain and benefiting more patients. |
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