Peripheral neuropathy is a common side-effect of chemotherapy and other cancer treatments. It typically involves tingling, numbness and pain in the fingers and toes. This pain is can increase in ‘glove and stocking’ type pattern up the limbs and to other areas.

Peripheral neuropathy affects 68% of patients undergoing chemotherapy. For 30% of patients, it is still present 6 months after the end of chemotherapy (Seretny 2014). For some people, it may be an ongoing issue.

Treating nerve pain is a priority. It is uncomfortable and it affects sleep and ability to relax. It can also affect independence - ability to get around and do things. Moreover, it is a common reason people reduce, change or stop their cancer treatments.

Currently there are very little treatment options found effective for chemotherapy induced peripheral neuropathy (CIPN). Your medical team can prescribe powerful pain-killers or anti-depressants, though they often have strong side-effects.

Acupuncture offers an option that addresses the nerve damage and facilitates a more rapid recovery.

Acupuncture treatment for patients with cancer - What should I expect?

A course of treatment usually involves 6-8 treatments. While preferable to have treatment twice weekly, significant results can be produced with once weekly treatments.

Each session involves the insertion of about 10-20 sterilised needles.

The treatment is very gentle and, for many people, pain-free. Needle location can vary from patient to patient. Most points are located below the elbows and knees. There are also points with efficacy in the ear. The needles are left in for 20-30 minutes.

Changes such as a decrease in symptoms can occur immediately after the first treatment or can take 2-3 treatments to occur. Generally the benefits of each treatment are compounded. A course of treatment is 6-8 treatments. Some patients will be recommended a second course of treatments to stabilise improvements.

How long does the pain-relief last?

Initially changes to pain symptoms may come and go, or severity may decrease for periods of time. Treatment is generally continued until symptoms (or lack of symptoms) have stabilised. At that point, the nerve damage has improved and treatment is not ongoing.

Will acupuncture help some people more than others?

The Franconi 2017 study reported that:

“From 7 trials assessed, results showed between 40-60% of participants (up yo 82% in one trial) produced measurable improvements” [6].

There is no evidence who will respond better to acupuncture.

Is acupuncture safe for cancer patients?

Acupuncture can safely be administered to people with bleeding disorders, on blood-thinning medications or with low white blood cell counts. Needles are much thinner than syringes used to take blood. For example, blood taking syringes tend to be 16-21mm in diameter, while acupuncture needles 0.2mm in diameter (thinner than a strand of hair).

Acupuncture is regularly administered on people who are currently receiving cancer treatment.

For patients suffering from lymphoedema, acupuncture is avoided on the affected limb. Alternative acupuncture points will be chosen to provide the intended result. To treat peripheral neuropathy with swollen legs, it is recommended to combine acupuncture with lymphoedema or lymphatic drainange massage.

Acupuncturists trained and registered to provide safe clinical treatments.

Should I see an acupuncturist who specialises in supporting patients with cancer?

It is always wise to check the qualifications and experience of your acupuncturist.

Some therapists have more experience working with cancer patients. There are acupuncture protocols currently being researched in the treatment of peripheral neuropathy. Some acupuncturists may be familiar with them.

Acupuncture is generally safe to administer by a qualified practitioner.

Acupuncture and Peripheral Neuropathy - what’s the evidence?

Currently, while clinical evidence exists about acupuncture successfully treating peripheral neuropathy, the conclusion is unclear. In regards to evidence, it may be the best option after the anti-depressant, duloxetine. The American Society of Clinical Oncology (ASCO) Clinical Practice Guideline reviewed all options for prevention and treatment in their 2014 guidelines. They made special mention of acupuncture citing “indications of improvement in symptoms and pain scores in most included studies” (Hershman, 2014).

Two other systematic reviews reported positive findings in clinical trials.

Franconi (2017) reviewed 7 clinical trials and positive effect in all trials for acupuncture in treating CIPN. The separate trials found acupuncture more effective than placebo sham acupuncture, Vitamin B12, control (usual care) and Neutropin. They recommended more studies, as trials needed to be more rigourous and larger scale.

Li (2019) reviewed 3 trials. Two found positive effect and one could not. They also recommended further studies though “acupuncture is considered safe and might provide relief for patients, it can be considered at the clinician’s discretion.”

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There is also more definitive laboratory research describing the mechanisms of how acupuncture works in the treatment of peripheral neuropathy.

Acupuncture Has Been Shown To Improve Neurological Function At The Site Of Nerve Damage

In cases of CIPN, the site of nerve damage is understood to be the sensory nerve cell bodies at the dorsal root ganglion. It is in the spine, affecting the nerves that supply the four limbs.

A 2013 study showed acupuncture for CIPN improves neurological function at the site of damaged dorsal root ganglions, in the spine.

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While in another study (Ko 2002), the expression of 68 genes had doubled in rats with neuropathic pain. However, these genes returned to normal after acupuncture treatment.

Acupuncture Stimulates The Body To Provide It's Own Pain Relief Endorphins

Acupuncture has been shown to stimulate the release of endorphins to decrease pain and increase a sense of well-being. Research has shown that the pain relief achieved with acupuncture works in the same pathways as opioid medications like codeine and endone (Pomeranz, 1976). However, there is no risk of addiction or withdrawal effects.

It Can Change The Function Of Our Nerve Receptors

Research has shown that acupuncture can have a significant effect on the number and function of our neurotransmitter receptors. This includes adrenergic, serotinergic, cholinergic and GABAnergic receptors (Ju, 2013). These receptors are found in our nerves in both the brain and peripheral nervous system.

So while acupuncture does not increase the level of neurotransmitters sending messages in our bodies, it can affect how we receive those messages.

References:

Franconi G, Manni L, Schröder S, Marchetti P, Robinson N. A systematic review of experimental and clinical acupuncture in chemotherapy-induced peripheral neuropathy. Evid Based Complement Alternat Med. 2013;2013:516916. doi: 10.1155/2013/516916

Hershman D, Lacchetti C, Dworkin R, Smith E, Bleeker J, Cavaletti G, Chauhan C, Gavin P, Lavino A, Lustberg M, Paice J, Schneider B, Smith M, Smith T, Terstriep S, Wagner-Johnston N, Bak K, and Loprinzi C. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline Journal of Clinical Oncology 2014 32:18, 1941-1967

Li K, Giustini D, Seely D. A systematic review of acupuncture for chemotherapy-induced peripheral neuropathy. Curr Oncol. 2019;26(2):e147–e154. doi:10.3747/co.26.4261

Yuxia Jin, Yunxia Wang, Jiayuan Zhang, Xiao Xiao, Qi Zhang. Efficacy and Safety of Acupuncture against Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis. Hindawi: Evidence-based Complementary and Alternative Medicine. Volume 2020, Article ID 8875433, doi/10.1155/2020/8875433

Ju Z, Cui H, Guo X, Yang H, He J, Wang K. Molecular mechanisms underlying the effects of acupuncture on neuropathic pain. Neural Regen Res. 2013;8(25):2350–2359. doi:10.3969/j.issn.1673-5374.2013.25.006

Kim W, Kim SK, Min BI. Mechanisms of electroacupuncture-induced analgesia on neuropathic pain in animal model. Evid Based Complement Alternat Med. 2013;2013:436913. doi:10.1155/2013/436913

Pomeranz B, Chiu D: Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci 1976, 19:1757-1762

Seretny M, Currie G, Sena E, Ramnarine S, Grant R, Macleod M, Colvin L, Fallon M. Incidence, prevalence and predictors of chemotherapy-induced peripheral neuropathy: A Systematic review and meta-analysis. Pain. 155 (2014) 2461-2470

CHEMOTHERAPY-INDUCED PERIPHERAL NEUROPATHY (CIPN)