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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