Peripheral Neuropathy

Chemotherapy-Induced Peripheral Neuropathy (CIPN)

 

Neuropathy is a common, frequently debilitating complication of cancer and its treatments.  Unfortunately, there is no simple solution to this problem.  It is possible that these patients represent a heterogeneous population and the underlying mechanisms of neuropathy may vary from individual to individual.  Many confounding factors exist, such as presence of diabetes mellitus or other circulatory disease.  The type of malignancy may be a factor also, some cancer such as myeloma may cause nerve damage itself.  Dose, type and duration of chemotherapy also play an important role in prognosis.  Personally, I believe that host factors should be taken into consideration too, such as nutritional status and degree of oxidative stress, that is, whether someone has adequate tissue levels of antioxidants for neuroprotection.

 

To date, no approved effective treatment is available for CIPN.  A number of drugs have been used for symptom management, including, pain medications, anti-epileptics, local anesthetics, and antidepressants.  Gabapentin, also known as neurontin, is widely used for neuropathic pain but in a double-blinded controlled crossover trial (n=115), Gabapentin is no more effective than placebo for CIPN.  Dr. Charles Loprinzi, a medical oncologist at the Mayo Clinic, conducted a controlled study using high dose of Gabapentin, 2700mg in divided doses per day and found no difference in symptom improvement.  Pregabalin or Lyrica has not been adequately tested, and in the clinical experience of some experts, it may be helpful in treating pain associated with CIPN, but not so much for numbness or tingling.  Many noticed drowsiness while on Gabapentin or Lyrica, weight gain is also observed among patients using Lyrica.

 

Many acupuncturists have treated patients with peripheral neuropathy (PN) including CIPN, with positive results.  As an experienced acupuncturist, I have treated many patients with PN and CIPN over the last 10 years.  Our own office records indicate that most patients reported at least 50% symptom improvement if they receive 8 or 10 treatments.  There are several publications in the medical literature, one study using ear acupuncture alone showed, when compared to two placebo groups, that the pain intensity decreased significantly after 2 months of therapy in Journal of Clinical Oncology.  2003, 21:4120-4126.  Another pilot trial consisting of five patients with chemo-induced peripheral neuropathy, all five of them experienced dramatic symptom improvement after acupuncture treatments.  Clearly, further clinical study is needed.

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