Effects of Nonpharmacological Interventions in Chemotherapy-Induced Peripheral Neuropathy: An Overview of Systematic Reviews and Meta-Analyses

Abstract

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is one of the prevalent and disabling side effects of cancer treatment. However, management strategies for CIPN currently remain elusive, with treatment restricted to neuropathic pain medications, supportive care, and chemotherapy dosing adjustments. This overview explores evidence on the potential benefits and safety of nonpharmacological interventions in preventing and treating CIPN in cancer patients. Methods: Seven databases were searched for systematic reviews of randomized controlled trials (RCTs). The methodological quality of the selected reviews was assessed by AMSTAR 2, and the quality of evidence was judged by GRADE. Twenty-eight systematic reviews were considered eligible for this review. Results: It was found that nonpharmacological interventions (acupuncture, exercise, herbal medicine, nutritional supplements) provided potential benefits for patients with CIPN. Furthermore, Chinese herbal medicine, administered orally or externally, significantly prevented and/or relieved the incidence and severity of CIPN in comparison to control groups (no additional treatment, placebo, and conventional western medicine). However, the quality of evidence and strength of recommendations were compromised by the inconsistencies and imprecision of included studies. The main concerns regarding the quality of systematic reviews included the lack of sufficiently rigorous a priori protocols, and the lack of protocol registration adopted in the included studies. Conclusions: Though looking across reviews, Chinese herbal medicine appear generally effective in CIPN, uncertainty remains about the effects of many other nonpharmacological interventions. The evidence on what works was particularly compromised by reporting and methodological limitations, which requires further investigation to be more certain of their effects.

Exercise for Neuropathic Pain: A Systematic Review and Expert Consensus

“…Chemotherapy-induced peripheral neuropathy, a common side effect of cancer treatment with a prevalence of 30–80%, is a small-fiber sensory neuropathy in the hands or feet ( 17 ). The typical symptoms are shooting pain, stabbing pain, or burning pain, which progressively becomes worse with chemotherapy ( 52 ).…”

“…Several clinical guidelines, systematic reviews, and metaanalyses regarding to clinical therapies for some specific diseases with NP symptoms have been published (12)(13)(14)(15)(16)(17). However, these guidelines and reviews more focus on pharmacological treatment; non-invasive treatments, such electrical and magnetic stimulation; and other non-pharmacological approaches, but not exercise.…”

Non-Pharmacological Self-Management Strategies for Chemotherapy-Induced Peripheral Neuropathy in People with Advanced Cancer: A Systematic Review and Meta-Analysis

“…These toxicities lead to prolonged infusion times, chemotherapy dose reductions, and treatment cessation, which has negative impacts on treatment efficacy and reduces the quality of life [12]. Unsurprisingly, non-pharmacological self-management interventions are of growing interest in assisting in the prevention and management of CIPN [14,16].…”

“…Non-pharmacological interventions are generally not first-line therapies for CIPN; however, there is emerging evidence to support their early use [13,16]. A recent systematic review of 24 controlled trials determined non-pharmacological interventions to be more effective than pharmacological treatments in managing Paclitaxel-induced peripheral neuropathy symptoms in people diagnosed with any cancer or stage [14].…”

“…A recent systematic review of 24 controlled trials determined non-pharmacological interventions to be more effective than pharmacological treatments in managing Paclitaxel-induced peripheral neuropathy symptoms in people diagnosed with any cancer or stage [14]. Specifically, beneficial effects on CIPN symptoms were described for Chinese herbal medicine, acupuncture, exercise, vitamin E and Omega-3 polyunsaturated fatty acid (PUFA) supplementation, massage, and foot baths [16]. ESMO Guidelines [13] recommend physical exercise as the only non-pharmacological therapy with Level 1 quality evidence for effectively treating neuropathic pain.…”