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Peripheral Neuropathy - CIPN

Peripheral neuropathy is a common side-effect of chemotherapy. While the condition can subside or resolve completely after cancer treatment, for some it can take quite a while or become an ongoing issue that affects daily life.


While medications can be effective at symptom relief, some people may prefer to avoid ongoing, over-use. Some people may prefer to address the nerve damage, rather than settle for pain relief.





Acupuncture and Peripheral Neuropathy – what’s the evidence?


Acupuncture has long been used to manage and treat peripheral neuropathy of all types.

While current clinical evidence of its efficacy is still unclear, a recent study has shown that acupuncture is more effective than sham acupuncture in improving the symptoms of chemotherapy-induced peripheral neuropathy (CIPN)[1].


Currently there is more research available describing the mechanisms of how acupuncture works in the treatment of peripheral neuropathy.

It 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[2]. 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[3]. 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.

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.

Acupuncture for this condition generally utilises established acupuncture points in the four limbs below the knees and elbows.


Studies have shown acupuncture for CIPN improves neurological function at the site of damaged dorsal root ganglions, in the spine[4].


While in another study, the expression of 68 genes had doubled in rats with neuropathic pain. However, they returned to normal after electroacupuncture treatment[5].

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 10-12 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, though some patients will return for a second course of treatments will improvements stabilise.

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 the pain is not expected to return.

Will acupuncture help some people more than others?


While high-quality evidence is still lacking, I refer to the only systematic review on the subject.


From 8 Trials Assessed, Results Showed Between 40-60% Of Participants (Up To 82% In One Trial) Produced Measurable Improvements. Two Trials Showed Improvements Better Than VitB12 And Neurotrpin, Respectively[6].


There is no evidence who will respond better to acupuncture.


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.

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 and will be familiar with the journey. 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. If you have any concerns, questions or would like a local referral, please feel free to contact me.

References:

[1] Giovanna Franconi, Luigi Manni, Sven Schröder, Paolo Marchetti, and Nicola Robinson, “A Systematic Review of Experimental and Clinical Acupuncture in Chemotherapy-Induced Peripheral Neuropathy,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 516916, 7 pages, 2013. https://doi.org/10.1155/2013/516916.

[2] Pomeranz B, Chiu D: Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci 1766, 19:1757-1762

[3] 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

[4] 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

[5] Ko J1, Na DS, Lee YH, Shin SY, Kim JH, Hwang BG, Min BI, Park DS. cDNA microarray analysis of the differential gene expression in the neuropathic pain and electroacupuncture treatment models. J Biochem Mol Biol. 2002 Jul 31;35(4):420-7.

[6] Giovanna Franconi, Luigi Manni, Sven Schröder, Paolo Marchetti, and Nicola Robinson, “A Systematic Review of Experimental and Clinical Acupuncture in Chemotherapy-Induced Peripheral Neuropathy,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 516916, 7 pages, 2013. https://doi.org/10.1155/2013/516916.

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