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Trends in Opioids and Nonpharmacologic Pain Management Among U.S. Cancer Survivors, 2011-2020.

Archives of physical medicine and rehabilitation·April 2026·Mitra McLarney, Stephen B Wechsler, Sadaf Arefi Milani et al.
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Key Finding

Multimodal pain treatment combining opioids and nonpharmacologic therapies (including acupuncture) among U.S. cancer survivors increased from 4% in 2011 to 10% in 2019, though nearly half remained untreated by 2020.

What This Means For You

Researchers examined how U.S. cancer survivors with pain managed their symptoms between 2011 and 2020, specifically looking at opioid medications, nonpharmacologic treatments like acupuncture, or combinations of both. The study analyzed data from over 41 million adults with cancer who experienced pain during this decade.

The research found encouraging trends in pain management approaches. Use of combined treatments—opioids plus nonpharmacologic therapies—increased from 4% in 2011 to 10% by 2019. Nonpharmacologic treatments included physical therapy, occupational therapy, chiropractic care, massage therapy, and acupuncture. Meanwhile, the percentage of cancer survivors receiving no pain treatment at all decreased from 62% to 46% during the same period.

However, the findings also revealed concerning disparities. Even by 2020, nearly half of cancer survivors with pain received no treatment. Access to nonpharmacologic treatments varied significantly based on income, education level, race, and geographic location, suggesting that not all patients have equal opportunities to access these therapies.

For cancer patients considering acupuncture as part of their pain management strategy, this study suggests growing acceptance of nonpharmacologic approaches, particularly when combined with conventional treatments. The increase in multimodal treatment use indicates that healthcare providers are becoming more open to integrating therapies like acupuncture alongside traditional pain medications. This is particularly relevant given concerns about opioid dependence and the desire for safer, non-addictive pain relief options.

If you're a cancer survivor experiencing pain and interested in acupuncture, discuss this option with your oncology team to ensure it's appropriate for your specific situation and find a licensed, board-certified acupuncturist experienced in working with cancer patients.

Clinical Notes for Practitioners

This serial cross-sectional study analyzed Medical Expenditure Panel Survey data (2011-2020) examining pain management trends among 41,064,668 noninstitutionalized U.S. adults with prevalent cancer and pain. Nonpharmacologic treatments assessed included physical therapy, occupational therapy, chiropractic care, massage therapy, and acupuncture.

Key findings demonstrated multimodal treatment (opioids plus nonpharmacologic therapies) prevalence increased from 4% (95% CI, 2%-6%) in 2011 to 10% (95% CI, 6%-14%) in 2019. Untreated patients decreased from 62% to 46% during this period. Adjusted relative risk ratio for nonpharmacologic treatment use remained stable 2011-2015 (RRR=1.00; 95% CI, 0.93-1.08) but increased 2016-2019 (RRR=1.22; 95% CI, 1.02-1.46) before declining in 2020 (RRR=0.68; 95% CI, 0.43-1.46).

Significant disparities existed based on income, education, race, and geographic region. Clinical takeaway: While multimodal approaches increased, most cancer pain survivors remained untreated, indicating substantial gaps in pain management and need for improved access to integrative therapies including acupuncture.

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