Effectiveness of Acupuncture Treatment on Chemotherapy-Induced Peripheral Neuropathy: A Pilot, Randomized, Assessor-Blinded, Controlled Trial.

Somayeh Iravani,Wenjun Sun,Mehrdad Karimi,Li Hou,Amir Hooman Kazemi Motlagh,Farhad Shahi,Mohammad Reza Afshari Fard,Baixiao Zhao,Mahdi Aghili,Seyede Zahra Emami Razavi,Hossein Rezaeizadeh,Jing Wang

doi:10.1155/2020/2504674

Abstract

Objective This pilot study aims to evaluate the effectiveness and safety of acupuncture in the treatment of chemotherapy-induced peripheral neuropathy (CIPN). Methods This study was a pilot randomized controlled trial, which was conducted with cooperation between Beijing University of Chinese Medicine (BUCM), China, and Tehran University of Medical Science (TUMS), Iran. Forty participants with CIPN were randomly assigned (1 : 1) to receive twelve sessions of acupuncture (20 minutes each session over 4 weeks) or take one 300 mg tablet of vitamin B1 and three 300 mg capsules of gabapentin per day for 4 weeks, after which both groups were followed up for 4 weeks. The primary endpoint was CIPN symptom severity measured by the Numerical Rating Scale (NRS). The secondary endpoints included sensory neuropathy grade evaluated by the National Cancer Institute-Common Toxicity Criteria for Adverse Events (NCI-CTCAE), neurophysiological assessment of CIPN by the nerve conduction study (NCS), and the patient overall satisfaction with treatment. Safety was assessed at each visit. Results The NRS and NCI-CTCAE sensory neuropathy grading scales decreased significantly over time in both groups (both P < 0.001), with a significantly higher reduction in the acupuncture group (P < 0.001 and P = 0.03, respectively). In addition, the acupuncture group showed a higher overall satisfaction with the treatment at the end of treatment and after 4 weeks follow-up, in comparison with the vit B1 and gabapentin group (P = 0.01 and P = 0.001, respectively). The NCS (except for the latency of the sural nerve) in the acupuncture group improved significantly (P < 0.05), while improvement in the vit B1 and gabapentin group was not observed (P > 0.05). Conclusion Our study revealed that acupuncture, as a kind of traditional Chinese therapeutic method, is significantly effective and safe in the treatment of CIPN. Moreover, acupuncture is more effective than using vitamin B1 and gabapentin as the conventional treatment. Trial registration. This trial is registered with the Iranian Registry of Clinical Trials (IRCT20190615043900N1).

Highlights

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common dose limiting adverse events of chemotherapeutic agents and is described as an injury to the peripheral nervous system due to neurotoxic chemotherapeutic agents [1] such as platinum compounds, taxanes, vinca alkaloids, bortezomib, and thalidomide [1, 2]
Design and Setting. is study is a pilot randomized controlled trial, which was conducted with cooperation between Beijing University of Chinese Medicine (BUCM), China, and Tehran University of Medical Science (TUMS), Iran, from June 2017 to December 2018. e study protocol was approved by the Ethics Committee Board of Beijing University of Chinese Medicine (2017BZHYLL0317) and of Tehran University of Medical Science (IR.TUMS.VCR.REC.1397.362). is study was performed according to the guidelines and principles of the Declaration of Helsinki
One patient in the acupuncture group refused to continue treatment for personal reasons. us, data of the 38 patients who completed the treatment and evaluation was included in the analysis (Figure 1)

Summary

Introduction

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common dose limiting adverse events of chemotherapeutic agents and is described as an injury to the peripheral nervous system due to neurotoxic chemotherapeutic agents [1] such as platinum compounds, taxanes, vinca alkaloids, bortezomib, and thalidomide [1, 2]. Neurotoxic drugs can induce an axonal poly neuropathy in different ways, such as by damaging microtubules, interfering with microtubule-related axonal transport, causing a disability of the mitochondria, making changes in the release of pain mediators such as growth factors, cytokines, and ion channels, and with cytotoxic effects on DNA [5]. Pathogenesis of CIPN, according to TCM, is deficiency of qi and blood, qi stagnation, and blood stasis, which leads to the malnourishment of tendons and vessels, and stasis in channels and collaterals [6]

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