Acupuncture Soothes Chemo-Induced Neuropathic Pain

Fran Lowry

December 08, 2011

December 8, 2011 — Acupuncture may help relieve the severe pain associated with chemotherapy-induced peripheral neuropathy (CIPN), according to the results of a small pilot study published in Acupuncture in Medicine.

The major groups of drugs that induce CIPN include the taxanes, vinca alkaloids, and platinum compounds, Sven Schroeder, MD, from the HanseMerkur Center for Traditional Chinese Medicine at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany, told Medscape Medical News.

"CIPN involves damage to the peripheral nervous system and can produce severe pain and gait impairment, and is often a reason for stopping chemotherapy with these agents," Dr. Schroeder said.

Data from other studies published in English-language journals on acupuncture as a symptomatic treatment for CIPN have been limited to a few case studies, but they have all reported an improvement in symptoms. Additionally, a Chinese study found that acupuncture was more effective than cobamamide for the treatment of sensory symptoms in paclitaxel-induced CIPN, he said.

"These findings are of special significance since peripheral neuropathy is otherwise almost untreatable, but seems to respond to treatment by acupuncture," Dr. Schroeder said.

In the current study, he and his team evaluated the therapeutic effect of acupuncture on CIPN as measured by changes in nerve conduction studies. The study population consisted of 11 patients who had developed symptoms of peripheral neuropathy during chemotherapy for a variety of cancers.

Acupuncture was offered to all patients with CIPN; 6 patients agreed to receive the treatment and 5 patients declined because the appointments were inconvenient for them.

The 6 patients were treated with acupuncture for 10 weeks in addition to receiving best medical care, and the 5 patients who declined acupuncture received best medical care but no specific treatment for CIPN.

During acupuncture treatment, 20 disposable, sterile needles were inserted at prescribed points to a depth of 10 to 30 mm and left in place for 20 minutes during each of the 10 sessions. Needle stimulation techniques were not used.

The acupuncture was performed on all patients by the same physician who had received more than 1000 hours of acupuncture training before participating in the trial and who had used acupuncture for 20 years.

The 6 patients in the acupuncture group were examined by nerve conduction studies a mean of 10 months (range, 2 - 21 months) after chemotherapy. These studies were performed to assess the signaling speed and intensity of 2 nerves in the same calf before treatment and again 6 months later after the end of treatment.

At the second neurologic assessment, patients in both groups were asked to state whether they thought their condition had changed or stayed the same.

Clinical examination showed that all the patients had a mixture of numbness on touch and nerve pain, and nerve conduction studies showed evidence of damage to the sural nerve.

The study found that acupuncture improved both the speed and the intensity of the nerve signaling in 5 of the 6 patients. These same patients also reported that their condition had improved.

In the control group, speed remained the same in 3, fell in 1, and improved in 1, and intensity remained the same in 1, improved in 2, and decreased in 2 patients, Dr. Schroeder reported.

"It has been shown that acupuncture may increase the blood flow in the limbs," he said, explaining how acupuncture might work in this condition. "Increased blood flow to the vasa nervorum and dependent capillary beds supplying the neurons may contribute to nerve repair with measurable improvement of axons or myelin sheaths."

Peripheral mechanisms possibly involved may include other types of fibers, such as the small unmyelinized or thinly myelinized fibers commonly believed to be undetected by nerve conduction studies, he added.

Also, the symptomatic effect of acupuncture may reflect morphologic changes in the anatomy of peripheral nerves and also complex derangements of central and peripheral regulation. "One hypothesis relates to the enhancement of conduction by the dorsal column or higher centers," Dr. Schroeder added.

His research team is planning a randomized, controlled trial, first in patients with diabetic neuropathy and next among those with CIPN, he said.

Dr. Schroeder has disclosed no relevant financial relationships.

Acupunct Med. Published online December 5, 2011. Abstract

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