Advancing perioperative care in breast oncology: The synergistic potential of electroacupuncture and nonsteroidal anti-inflammatory drugs analgesia

Abstract

This editorial examines the case control study by He et al recently published in World Journal of Clinical Oncology, which investigates the synergistic effects of perioperative electroacupuncture (EA) combined with flurbiprofen axetil (FA) on pain management and functional recovery following breast cancer surgery. In the study involving 130 patients, the EA group demonstrated a significant reduction in the incidence of moderate-to-severe movement-evoked pain and lower Visual Analog Scale scores at rest and during movement at 24 hours postoperatively compared to controls receiving sham acupuncture and FA. Enhanced recovery was further evidenced by superior scores in basic activities of daily living, including grooming, dressing, and transferring, alongside a notable decrease in postoperative complications such as nausea and vomiting. These findings underscore EA’s potential as a valuable, non-opioid adjunct within a multimodal analgesic regimen, contributing to improved early postoperative outcomes and aligning with enhanced recovery after surgery principles. While the study provides robust evidence for short-term synergistic analgesia, future research should aim to standardize EA protocols, elucidate its neurophysiological mechanisms, particularly its interaction with inflammatory pathways and central sensitization, and evaluate its long-term impact on patient-reported quality of life, chronic pain development, and overall oncological recovery trajectories.

Key Words: Electroacupuncture; Postoperative pain; Breast cancer surgery; Functional recovery; Integrative oncology

Core Tip: While electroacupuncture (EA) has been studied for managing breast cancer treatment-related symptoms (e.g., neuropathy, arthralgia), this editorial highlights its emerging role as a synergistic perioperative analgesic. The discussed case control study demonstrates that EA combined with flurbiprofen axetil significantly improves postoperative pain control, functional recovery, and reduces complications. This positions EA as a key multimodal component within enhanced recovery after surgery protocols and underscores its potential as a model for integrating evidence-based complementary interventions across the entire continuum of cancer care, from surgery to survivorship.

This editorial refers to “Effects of electroacupuncture combined with flurbiprofen axetil on postoperative pain and early functional recovery after breast cancer surgery” by He et al, 2026; https://doi.org/10.5306/wjco.v17.i2.114431.

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INTRODUCTION

Postoperative recovery following breast cancer surgery is frequently complicated by acute pain, which can impede early mobilization, delay discharge, and diminish quality of life[1,2]. While pharmacologic analgesia, particularly nonsteroidal anti-inflammatory drugs and opioids, forms the cornerstone of management, limitations such as side effects and dependency concerns persist[3,4]. Consequently, the integration of evidence-based non-pharmacologic modalities into multimodal analgesic regimens is a priority within enhanced recovery after surgery (ERAS) pathways. The study by He et al[5], which investigates the effects of perioperative electroacupuncture (EA) combined with flurbiprofen axetil (FA) on pain and functional recovery, arrives at a pivotal moment. It addresses a specific clinical gap while contributing to a broader, evolving narrative regarding the role of EA across the continuum of breast cancer care. Beyond symptom management for treatment-induced side effects such as arthralgia, hot flashes, and chemotherapy-induced peripheral neuropathy (CIPN)[6,7], emerging preclinical and clinical data suggest EA may influence tumor biology and the immune microenvironment[8,9]. Thus, this case control study is not merely an evaluation of an analgesic adjunct but a significant piece in the larger puzzle of integrating complementary modalities into modern, multidisciplinary oncology practice[10,11].

FINDINGS AND MECHANISTIC INTERPRETATIONS: TOWARDS A MULTISYSTEM SYNERGY

In a recent issue of the World Journal of Clinical Oncology, He et al[5] reported a case control study. The study demonstrates that EA, administered from the preoperative period through surgery, significantly reduces the incidence of moderate-to-severe movement-evoked pain and Visual Analog Scale scores at 24 hours postoperatively compared to sham acupuncture with FA[5]. Notably, improvements were also observed in basic activities of daily living and a reduction in complications like nausea and vomiting. These results suggest a synergistic effect between EA and FA that extends beyond simple analgesia.

The underlying mechanisms for this synergy can be conceptualized through a multisystem framework. Firstly, FA exerts its effect peripherally by inhibiting cyclooxygenase and prostaglandin synthesis. EA is postulated to activate complementary central and systemic pathways. It may stimulate the release of endogenous opioids and neurotransmitters, modulating pain perception at the spinal and supraspinal levels[12].

Furthermore, evidence suggests EA can attenuate systemic inflammation, a key driver of postoperative pain and recovery. For instance, EA has been shown to reduce pro-inflammatory cytokines such as interleukin-1β and tumor necrosis factor-α through vagus nerve activation, a mechanism that could synergize with the peripheral anti-inflammatory action of FA[13].

Additionally, EA may stabilize autonomic nervous system function, potentially mitigating surgical stress-induced fluctuations in heart rate and blood pressure, thereby contributing to overall patient stability and comfort[14]. The differential effects of various EA frequencies on sensory vs motor symptoms, as observed in studies on CIPN, hint at a nuanced neuro-modulation that future perioperative studies could seek to optimize[15,16].

Therefore, the combined regimen likely targets the nociceptive, inflammatory, and neuroendocrine components of postoperative stress through distinct but convergent pathways, resulting in enhanced analgesic efficacy and improved functional outcomes[17].

CLINICAL INTEGRATION AND BROADER IMPLICATIONS IN CANCER CARE

The immediate clinical implication of this study is the validation of EA as a valuable component within ERAS protocols for breast surgery[18]. Its benefits are multidimensional, acting as an analgesic, an anti-emetic, and a functional recovery accelerator simultaneously. This aligns with other research demonstrating EA’s efficacy in reducing preoperative anxiety and improving postoperative sleep quality in similar patient populations, thereby addressing the psychological dimensions of recovery[19].

More broadly, this study strengthens the evidentiary foundation for EA as a versatile supportive therapy throughout the breast cancer journey[20]. Prior research has established its utility in managing aromatase inhibitor-induced arthralgia, chemotherapy-induced nausea and vomiting (CINV), and CIPN[7,21]. Robust randomized controlled trials (RCTs) have shown specific EA protocols can significantly improve complete response rates in CINV when added to standard antiemetics and reduce the incidence and severity of CIPN[22,23]. Furthermore, EA has demonstrated positive effects on cancer-related fatigue, insomnia, and cognitive impairment[24,25]. The study by He et al[5] contributes a high-quality dataset in the perioperative setting, a critical phase that bridges diagnosis with adjuvant therapy. By demonstrating safety, patient acceptance, and efficacy in this context, it enhances the overall credibility and facilitates the conceptualization of EA as a standardized, low-burden supportive option that can be tailored to different phases of treatment, from surgery through survivorship[26].

LIMITATIONS AND FUTURE DIRECTIONS: FROM OPTIMIZATION TO TRANSLATIONAL EXPLORATION

While promising, the study has limitations that must be acknowledged to guide future research. These include a single-center design, a relatively short primary observation period focused on acute recovery, and the inherent challenges associated with sham acupuncture controls, which may not be physiologically inert[27]. The optimal EA parameters, including stimulation frequency, intensity, treatment duration, and timing relative to surgery, remain to be fully elucidated.

Future studies should progress along several complementary tracks. First, large-scale, multicenter RCTs are needed to confirm these findings and assess long-term outcomes; broader clinical adoption should be contingent upon such validation. Second, mechanistic studies should employ biomarkers to quantify the proposed anti-inflammatory and neuroendocrine effects of perioperative EA in humans. Third, a prioritized research objective should be the identification and validation of biomarkers capable of predicting which patients are most likely to derive significant analgesic or functional benefit from EA, advancing toward personalized application[28].

Perhaps the most intriguing future direction is inspired by preclinical evidence. Studies in murine models indicate that peritumoral EA can induce tumor vascular normalization, modulate tumor-associated macrophages, enhance antitumor immunity, and even directly inhibit tumor growth in triple-negative breast cancer[8,9,29,30]. This raises a provocative, long-term translational question: Could the systemic anti-inflammatory and immunomodulatory effects elicited by EA in the perioperative period, as suggested by reduced complications and improved recovery, also exert a favorable distant effect on the pre-metastatic niche or residual disease? Exploring potential impacts on long-term oncological outcomes, such as recurrence-free survival, represents a frontier where supportive care and anti-tumor strategy may converge. Initial steps would involve correlating perioperative EA-induced immunologic changes with long-term follow-up data.

CONCLUSION

In conclusion, the study by He et al[5] provides compelling evidence that EA effectively augments FA analgesia, improving pain control, functional recovery, and reducing complications after breast cancer surgery. Its significance extends beyond the immediate perioperative context; it robustly contributes to the growing paradigm of integrating EA into the comprehensive, multidisciplinary management of breast cancer. This research encourages not only the adoption of EA within ERAS pathways but also underscores the necessity for further rigorous investigation. As the field evolves, collaboration between surgical oncologists, anesthesiologists, integrative medicine specialists, and basic scientists will be essential to fully delineate the mechanisms, optimize the protocols, and explore the ultimate potential of this ancient therapy in improving the entirety of the cancer care experience.