1
|
Jiang J, Zhan L, Jiang B, Pan J, Hong C, Chen Z, Yang L. Anticancer therapy-induced peripheral neuropathy in solid tumors: diagnosis, mechanisms, and treatment strategies. Cancer Lett 2025; 620:217679. [PMID: 40154913 DOI: 10.1016/j.canlet.2025.217679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 03/21/2025] [Accepted: 03/25/2025] [Indexed: 04/01/2025]
Abstract
Anticancer therapy-induced peripheral neuropathy (PN) is a common adverse event during the diagnosis and treatment of solid tumors. The drug class, cumulative dose, and individual susceptibility affect the incidence and severity of PN. Owing to the lack of specific biomarkers and imaging tests, the diagnostic criteria for PN remain unclear. Moreover, the available and effective clinical treatment strategies are very limited, and most of the current drugs focus on symptom management rather than fundamental reversal of the disease course. The morbidity mechanisms of PN are diverse, including direct neurotoxicity, mitochondrial dysfunction, and disruption of axonal transport. Here, we summarize the diagnosis, mechanisms, and neuroprotective strategies of PN and discuss potential intervention treatments.
Collapse
Affiliation(s)
- Jiahong Jiang
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Luying Zhan
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Boyang Jiang
- The Clinical Medical College, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jingyi Pan
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chaojin Hong
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zheling Chen
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
| | - Liu Yang
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
| |
Collapse
|
2
|
Samala RV, Patel C, Pappin C, McInnes S, Neale K, Lagman R, Shoemaker L. A Palliative Care Clinic's Early Experience with Scrambler Therapy. J Palliat Med 2025. [PMID: 40388312 DOI: 10.1089/jpm.2025.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2025] Open
Abstract
Background: Studies continue to emerge demonstrating the effectiveness of scrambler therapy (ST) in treating chronic neuropathic pain. Objective: To describe our ST program and the first eight months of referral and treatment outcomes. Design: Retrospective pilot study. Setting/Subjects: Patients with chronic neuropathy in a Midwest U.S. palliative care (PC) clinic. Measurements: Demographic information, morphine equivalent daily dose, and self-reported numerical pain level before and after treatment. Results: From November 1, 2022, to June 30, 2023, we received 78 referrals. Twenty-nine patients declined initial consultation, mostly due to cost, and 12 continued to full treatment. The mean age was 59; 67% were male; majority had chemotherapy-induced neuropathy and were on opioid therapy. Seven of 12 patients reported satisfactory reduction in pain level by the last day of treatment. Five patients reported marked decreases in opioid analgesic use. Conclusion: Our early experience using ST was characterized by variable response and limited by the cost of treatment.
Collapse
Affiliation(s)
- Renato V Samala
- The Lois U. and Harry R. Horvitz Palliative Medicine Program, Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chirag Patel
- The Lois U. and Harry R. Horvitz Palliative Medicine Program, Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Catherine Pappin
- The Lois U. and Harry R. Horvitz Palliative Medicine Program, Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susan McInnes
- The Lois U. and Harry R. Horvitz Palliative Medicine Program, Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kyle Neale
- The Lois U. and Harry R. Horvitz Palliative Medicine Program, Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ruth Lagman
- The Lois U. and Harry R. Horvitz Palliative Medicine Program, Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura Shoemaker
- The Lois U. and Harry R. Horvitz Palliative Medicine Program, Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
3
|
Ye AL, Abdi S. Beyond p-values: a cross-sectional umbrella review of chemotherapy-induced peripheral neuropathy treatments. FRONTIERS IN PAIN RESEARCH 2025; 6:1564662. [PMID: 40176845 PMCID: PMC11961875 DOI: 10.3389/fpain.2025.1564662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Accepted: 02/25/2025] [Indexed: 04/04/2025] Open
Abstract
Introduction Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of neurotoxic chemotherapy agents, significantly impacting the daily lives of many cancer survivors. Despite thousands of articles published on CIPN, we remain no closer to a successful treatment regimen for the condition. In recent years, several new clinical trials and systematic reviews have been published, many exploring nonpharmaceutical interventions, prompting the need for a comprehensive synthesis of this emerging evidence. Methods We conducted an umbrella review to identify and appraise the 19 systematic reviews (SRs) published in 2023 that examined randomized controlled trials (RCTs) for established CIPN treatment. We focused our analysis on the three most researched treatment options: oral drugs, exercise, and acupuncture. RCTs not previously synthesized together were reviewed, and effect size analyses were performed to allow readers to interpret the existing literature beyond binary p-values. Results Our analysis of RCTs revealed the following key findings. For cancer survivors with CIPN after completing chemotherapy, serotonin-norepinephrine reuptake inhibitors (SNRIs) as well as acupuncture provided at least short-term relief for pain and sensory symptoms. For patients with CIPN who were actively undergoing chemotherapy, home-based balance and strength training exercises appeared to alleviate symptoms. Effect size analyses highlighted variability in treatment responses, underscoring the limitations of relying solely on p-values to assess intervention efficacy. Discussion Through an umbrella review approach, we demonstrate that SRs are often less systematic than expected. None of the 19 SRs captured all relevant RCTs within their search timeframe. However, by cross-referencing SRs, we identified 41 RCTs across 42 publications, illustrating the feasibility of an umbrella review approach to uncover relevant trials. Furthermore, many SRs exhibited methodological concerns that limit the interpretability of their findings. Finally, we discuss multiple opportunities for refining methods and reporting in future CIPN treatment trials. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024508283, PROSPERO (42024508283).
Collapse
Affiliation(s)
| | - Salahadin Abdi
- Department of Pain Medicine, The University of Texas MD Anderson Texas Center, Houston, TX, United States
| |
Collapse
|
4
|
Hino U, Tamura R, Toda M. Optimal Delivery of Pain Management in Schwannomatosis: A Literature Review. Ther Clin Risk Manag 2025; 21:61-68. [PMID: 39839825 PMCID: PMC11748755 DOI: 10.2147/tcrm.s362794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 01/04/2025] [Indexed: 01/23/2025] Open
Abstract
Non-NF2 schwannomatosis is a rare syndrome characterized by multiple benign schwannomas that primarily affect nerve sheaths, with chronic, treatment-resistant pain as the most common symptom. No protocol has been established for pain management, and pharmacotherapies, including molecular target therapies, are being evaluated. Neuromodulation therapies such as scrambler therapy and surgical options are also employed; however, surgery may lead to persistent or recurrent pain caused by nerve damage or tumor recurrence. The lack of accurate animal models hampers understanding of pain mechanisms and tumor development, necessitating further basic research and clinical trials to improve treatment strategies.
Collapse
Affiliation(s)
- Utaro Hino
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Ryota Tamura
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
5
|
Lukkahatai N, Nguyen MV, Zhang J, Cho YM, Benjasirisan C, Jia HM, Campbell CM, Kawi J, Wu H, Wang H, Bora R, Thrul J, Johnson CM, Smith TJ. A randomized controlled study of auricular point acupressure to manage chemotherapy-induced neuropathy: Study protocol. PLoS One 2024; 19:e0311135. [PMID: 39325795 PMCID: PMC11426428 DOI: 10.1371/journal.pone.0311135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 09/11/2024] [Indexed: 09/28/2024] Open
Abstract
OBJECTIVE Chemotherapy-induced neuropathy (CIN) significantly impacts cancer patients, leading to functional disability, diminished quality of life, and increased healthcare costs amid the ongoing opioid crisis. Auricular point acupressure (APA), a non-invasive and non-pharmacological alternative, has shown potential for alleviating the pain, numbness, and tingling associated with CIN. This study aims to assess the efficacy of APA for CIN symptoms and physical function and to examine the mechanisms underlying APA's effects on CIN. METHODS This is a three-arm randomized controlled clinical trial protocol. Patients aged 18 and older who are experiencing CIN are randomly assigned to one of the three groups: an APA group (in-person APA; mAPA), a sham control group (virtual APA; vAPA), and a wait-list usual care control group (UC). During the four-week program, participants in the mAPA receive an in-person APA treatment and training; the sham control participants (vAPA) receive a self-guided smartphone APA application with APA demonstration videos; and the UC participants will continue with the usual care and be re-randomized into one of the APA groups. The primary outcomes are changes in CIN symptoms and physical function. Secondary outcomes include evaluating pain sensory thresholds, motor and cognitive functioning, inflammatory signaling, brain connectivity, opioid use, and quality of life. The outcomes are measured at baseline, program completion (4 weeks), and at monthly follow-up for 3 months post-intervention. DISCUSSION This study will provide evidence supporting the potential viability of APA as an intervention for CIN. TRIAL REGISTRATION ClinicalTrials.gov, ID NCT04920097 registered on 3 June 2021.
Collapse
Affiliation(s)
- Nada Lukkahatai
- Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States of America
| | - Michael V. Nguyen
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, United States of America
| | - Jingyu Zhang
- Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
| | - Yu-Min Cho
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, Houston, TX, United States of America
| | | | - Heijingzi Monica Jia
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Claudia M. Campbell
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Jennifer Kawi
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, Houston, TX, United States of America
| | - Hulin Wu
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States of America
| | - Hongyu Wang
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, United States of America
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, Houston, TX, United States of America
| | - Rupsikha Bora
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, Houston, TX, United States of America
| | - Johannes Thrul
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Constance M. Johnson
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, Houston, TX, United States of America
| | - Thomas J. Smith
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| |
Collapse
|
6
|
Xu R, Yu C, Zhang X, Zhang Y, Li M, Jia B, Yan S, Jiang M. The Efficacy of Neuromodulation Interventions for Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis. J Pain Res 2024; 17:1423-1439. [PMID: 38628429 PMCID: PMC11020285 DOI: 10.2147/jpr.s448528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose To determine the efficacy and safety of a neuromodulation intervention regimen in the treatment of chemotherapy-induced peripheral neuropathy (CIPN). Patients and Methods Systematic searches were conducted in seven English databases. Randomized controlled trials of all neuromodulation interventions (both invasive and non-invasive) for the treatment of CIPN were selected. Group comparisons of differences between interventions and controls were also made. We divided the outcomes into immediate-term effect (≤3 weeks), short-term effect (3 weeks to ≤3 months), and long-term effect (>3 months). Results Sixteen studies and 946 patients with CIPN were included. Among immediate-term effects, neuromodulation interventions were superior to usual care for improving pain (SMD=-0.77, 95% CI -1.07~ 0.47), FACT-Ntx (MD = 5.35, 95% CI 2.84~ 7.87), and QOL (SMD = 0.44, 95% CI 0.09~ 0.79) (moderate certainty); neuromodulation loaded with usual care was superior to usual care for improving pain (SMD=-0.47, 95% CI -0.71 ~ -0.23), and QOL (SMD = 0.40, 95% CI 0.12 ~ 0.69) (moderate certainty). There were no statistically significant differences between the neuromodulation interventions regimen vs usual care in short- and long-term outcomes and neuromodulation vs sham stimulation from any outcome measure. There were mild adverse events such as pain at the site of stimulation and bruising, and no serious adverse events were reported. Conclusion Neuromodulation interventions had significant immediate-term efficacy in CIPN but had not been shown to be superior to sham stimulation; short-term and long-term efficacy could not be determined because there were too few original RCTs. Moreover, there are no serious adverse effects of this therapy.
Collapse
Affiliation(s)
- Runbing Xu
- Hematology and Oncology Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Changhe Yu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Xinyu Zhang
- Hematology and Oncology Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Yipin Zhang
- Hematology and Oncology Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Mengfei Li
- Hematology and Oncology Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Bei Jia
- Hematology and Oncology Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Shiyan Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Miao Jiang
- Hematology and Oncology Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People’s Republic of China
- School of Life Science, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| |
Collapse
|
7
|
Zhang X, Wang A, Wang M, Li G, Wei Q. Non-pharmacological therapy for chemotherapy-induced peripheral neurotoxicity: a network meta-analysis of randomized controlled trials. BMC Neurol 2023; 23:433. [PMID: 38082216 PMCID: PMC10712106 DOI: 10.1186/s12883-023-03485-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neurotoxicity (CIPN) is the most common adverse effect in patients undergoing chemotherapy, and no effective interventions are currently available for its prevention and treatment. Non-pharmacological therapies appear to be beneficial for the prevention and treatment of CIPN, but it remains unclear which therapy is most effective. The aim of this study was to identify the most effective non-pharmacological therapy for CIPN patients. METHODS PubMed, Web of Science, Embase, and Cochrane Library were searched for randomized controlled trials on non-pharmacological therapies for CIPN. The primary outcomes included pain and peripheral neuropathological symptoms, and the secondary outcomes included quality of life, sensory and motor symptoms. The pairwise analysis and a network meta-analysis were performed using a random effects model. RESULTS A total of 46 articles were included in this study, involving 2,878 participants. Our study showed that massage was more effective in pain-alleviating compared with acupuncture [SMD = 0.81, 95%CI (0.04, 1.57)], vitamin and gabapentin [SMD = 2.56, 95%CI (1.39, 3.74)], and usual care and placebo [SMD = 0.9, 95%CI (0.31, 1.49)]. As for attenuating peripheral neuropathological symptoms, massage was more effective than usual care and placebo [SMD = 0.75, 95%CI (0.33, 1.17)], sensorimotor training [SMD = 1.17, 95%CI (0.24, 2.10)], electrostimulation [SMD=-1.18, 95%CI (-2.14, -0.21)], multimodal exercise [SMD=-0.82, 95%CI (-1.57, -0.08)], and resistance training [SMD = 1.03, 95%CI (0.11, 1.95)]. Massage was also more effective than other non-pharmacological therapies in improving quality of life, sensory and motor symptoms. CONCLUSIONS According to our study, massage has advantages in alleviating pain, improving quality of life, and improving peripheral neuropathological symptoms and has better effect than other non-pharmacological interventions, representing certain clinical significance. However, the results of this study should be interpreted with caution due to the limitations of the included studies. In the future, more high-quality multi arm randomized controlled trials can be attempted to provide direct comparisons of the relative effects of non-pharmacological interventions.
Collapse
Affiliation(s)
- Xia Zhang
- Rehabilitation Medicine Center, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Ao Wang
- Rehabilitation Medicine Center, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Miaowei Wang
- Rehabilitation Medicine Center, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Guo Li
- Rehabilitation Medicine Center, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Quan Wei
- Rehabilitation Medicine Center, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China.
| |
Collapse
|
8
|
Karri J, Marathe A, Smith TJ, Wang EJ. The Use of Scrambler Therapy in Treating Chronic Pain Syndromes: A Systematic Review. Neuromodulation 2023; 26:1499-1509. [PMID: 35691908 DOI: 10.1016/j.neurom.2022.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/05/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Scrambler therapy (ST) is a noninvasive method of transcutaneous neuromodulation that has 510(K) clearance from the United States Food and Drug Administration for treating acute pain, postoperative pain, and intractable chronic pain. Since its inception, ST has been used to treat many chronic pain syndromes in a variety of patient populations. We synthesized the available literature for ST to delineate its overall evidence basis. MATERIALS AND METHODS We performed a systematic review based on conventional Preferred Reporting Items for Systematic Reviews and Meta-Analyses methods by surveying multiple data sources from January 1950 through October 2021. Two review authors, independently and in a standardized, unblinded fashion, conducted a systematic review to identify relevant studies and extract the necessary outcome measures. A conservative search strategy was implemented to identify all ST studies for the treatment of chronic pain syndromes. Primary outcome parameters collected were analgesic benefit, adverse effects, and other metrics such as sensorimotor testing. RESULTS A total of 21 studies met the final criteria for study inclusion and comprised randomized controlled trials (n = 8), prospective observational studies (n = 10), and retrospective cohort studies (n = 3). Nearly all the reported studies explored the use of ST for the treatment of neuropathic pain, with chemotherapy-induced peripheral neuropathy being the most studied condition. Most studies were limited by small cohorts but reported ST being safe, well tolerated, and providing clinically meaningful pain reduction. The duration of posttreatment follow-up ranged from ten to 14 days (concordant with completion of typical ST protocols) to three months. Secondary benefits such as medication reduction and improvement of sensory and motor symptoms were noted by some studies. CONCLUSIONS ST is regarded as a safe intervention with potential for significant analgesic benefit for neuropathic pain conditions. Although the available evidence is most robust for treating chemotherapy-induced peripheral neuropathy, ST has also been shown to be effective in treating other neuropathic pain syndromes. Evidence for ST use in nociceptive pain conditions is limited but appears promising. The favorable safety profile and increasing evidence basis for ST warrant more extensive recognition and consideration for use in clinical care.
Collapse
Affiliation(s)
- Jay Karri
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | - Thomas J Smith
- Department of Internal Medicine, Division of General Medicine, and Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA; Department of Internal Medicine, Division of Palliative Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
9
|
Molinares D, Kurtevski S, Zhu Y. Chemotherapy-Induced Peripheral Neuropathy: Diagnosis, Agents, General Clinical Presentation, and Treatments. Curr Oncol Rep 2023; 25:1227-1235. [PMID: 37702983 DOI: 10.1007/s11912-023-01449-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE OF REVIEW This review aims to discuss pathophysiology, diagnosis, clinical presentation, and treatment of chemotherapy-induced peripheral neuropathy. Agent-specific presentation and pathophysiology is also being discussed. RECENT FINDINGS As new systemic oncological treatments continue to be developed, the number of cancer survivors continues to grow. Survivors are living longer with the long-term side effects of oncological treatments. We reviewed the pathophysiology of agent-specific chemotherapy-induced peripheral neuropathy and the updates in its treatment and preventative tools. Chemotherapy-induced peripheral neuropathy is a debilitating long-term side effect that often impairs cancer survivors' function and quality of life. The increasing life expectancy of cancer survivors has resulted in increased prevalence of this condition. Understanding its intricacies can provide physicians with better treatment tools and research opportunities to develop or identify new therapeutic agents.
Collapse
Affiliation(s)
- Diana Molinares
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, 1611 NW 12th avenue, Miami, FL, 33136, USA.
| | - Sara Kurtevski
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, 1611 NW 12th avenue, Miami, FL, 33136, USA
| | - Yingrong Zhu
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, 1611 NW 12th avenue, Miami, FL, 33136, USA
| |
Collapse
|
10
|
D'Souza RS, Alvarez GAM, Dombovy-Johnson M, Eller J, Abd-Elsayed A. Evidence-Based Treatment of Pain in Chemotherapy-Induced Peripheral Neuropathy. Curr Pain Headache Rep 2023; 27:99-116. [PMID: 37058254 DOI: 10.1007/s11916-023-01107-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE OF REVIEW Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and often painful condition that occurs after administration of chemotherapeutic agents. The primary objective of this systematic review was to appraise the literature on conservative, pharmacological, and interventional treatment options for CIPN pain. RECENT FINDINGS There is level I evidence supporting modest to moderate improvement in CIPN pain from duloxetine treatment, as well as short-term modest improvement from physical therapy and acupuncture. Although opioid and cannabis administration may provide short-term modest improvement, administration is commonly limited by side effects. Generally, most studies reported no clinical benefit from yoga, topical neuropathic agents, gabapentinoids, and tricyclic antidepressants. Evidence is currently equivocal for scrambler therapy and transcutaneous electrical nerve stimulation. Finally, evidence on neuromodulation options is limited to mostly case reports/series and one observational study highlighting moderate improvement with auricular nerve stimulation. This systematic review provides an overview of conservative, pharmacologic, and interventional treatment modalities for CIPN pain. Furthermore, it provides a level of evidence and degree of recommendation based on the United States Preventive Services Task Force (USPSTF) criteria for each specific treatment modality.
Collapse
Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | | | - Marissa Dombovy-Johnson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital, Rochester, MN, USA
| | - Jennifer Eller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.
| |
Collapse
|
11
|
Chemotherapy: how to reduce its adverse effects while maintaining the potency? Med Oncol 2023; 40:88. [PMID: 36735206 DOI: 10.1007/s12032-023-01954-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
Chemotherapy is one of the widely used anticancer treatments that involves the use of powerful cytotoxic drugs to stop tumor growth by targeting rapidly dividing cells through various mechanisms, which will be elucidated in this review. Introduced during the early twentieth century, chemotherapy has since lengthened the longevity of innumerable cancer patients. However, the increase in lifespan is at the expense of quality of life as patients are at risk of developing short-term and long-term side effects following chemotherapy, such as alopecia (hair loss), chemotherapy-induced peripheral neuropathy, chemotherapy-induced nausea and vomiting, cardiotoxicity, diarrhea, infertility, and chemo brain. Currently, a number of these chemotherapy-induced adverse effects are managed through supportive care and approved treatments, while the rest of the side effects are unavoidable. Hence, chemotherapeutic drugs associated with inevitable side effects are only administered when their therapeutic role outweighs their chemotoxicity, thus severely limiting the potency of chemotherapy in treating malignancy. Therein, the potential approaches to alleviating side effects of chemotherapy ranging from pharmaceutical drugs to alternative therapies will be discussed in this review in hopes of increasing the tolerance and effectiveness of future chemotherapeutic treatments.
Collapse
|
12
|
Jones KF, Wechsler S, Zulewski D, Wood L. Pharmacological and Nonpharmacological Management of Chemotherapy-Induced Peripheral Neuropathy: A Scoping Review of Randomized Controlled Trials. J Palliat Med 2022; 25:964-995. [PMID: 35128938 PMCID: PMC9145589 DOI: 10.1089/jpm.2021.0512] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatment with no effective preventative strategy or definitive treatment. Purpose: To synthesize empiric literature from randomized controlled trials (RCTs) of pharmacological and nonpharmacological management of CIPN. Data Sources: Articles published between January 1, 2010, and February 28, 2021, were identified using keywords searching Medline, PubMed, CINAHL, Web of Science, Cochrane Library, and Embase. Study Selection: RCTs that recruited individuals who were post-chemotherapy and experienced persistent CIPN symptoms. Data Extraction and Synthesis: Three independent reviewers screened a total of 2023 abstracts. After screening, full-text review, and quality appraisal, 22 articles were included in this review. Data related to study design, participant characteristics, interventions, controls, outcome measures, and relevant findings were extracted from full texts. Descriptive quantitative summaries were calculated and narrative analysis was performed. Results: Of the 22 studies, 4 investigated pharmacologic treatments, 2 compared acupuncture to pharmacologic treatments, and 16 studies examined nonpharmacologic treatments. Pharmacologic studies reported mixed results with evidence of participant response varying by history of chemotherapeutic agent. Acupuncture, exercise/physical therapy, and neurofeedback appear to be effective treatments for CIPN. Evidence regarding biophysical agents and cognitive-behavioral therapy is equivocal. Scrambler therapy is not supported. Limitations: Studies included in this review share several limitations, including widely variable outcome measures, small and demographically homogenous samples, and nonstandardized treatment protocols. Conclusion: This scoping review summarized the current body of high-quality RCTs investigating treatment for CIPN. The majority of studies in this review reports benefits of pharmacologic and nonpharmacologic interventions, although management may require a multipronged approach and should be tailored to the individual. Clinical implications are proposed and suggestions made for future research include implementation of standardized intervention protocols, use of outcome measures representative of the spectrum of CIPN symptoms, and stratification by the chemotherapeutic agent.
Collapse
Affiliation(s)
| | - Stephen Wechsler
- Massachusetts General Hospital Institute for Health Professionals, School of Rehabilitation Science, Boston, Massachusetts, USA
| | - David Zulewski
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Lisa Wood
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| |
Collapse
|
13
|
Wang M, Yin Y, Yang H, Pei Z, Molassiotis A. Evaluating the safety, feasibility, and efficacy of non-invasive neuromodulation techniques in chemotherapy-induced peripheral neuropathy: A systematic review. Eur J Oncol Nurs 2022; 58:102124. [DOI: 10.1016/j.ejon.2022.102124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/04/2022]
|
14
|
Tamburin S, Park SB, Schenone A, Mantovani E, Hamedani M, Alberti P, Yildiz-Kabak V, Kleckner IR, Kolb N, Mazzucchelli M, McNeish BL, Argyriou AA, Cavaletti G, Hoke A. Rehabilitation, exercise, and related non-pharmacological interventions for chemotherapy-induced peripheral neurotoxicity: Systematic review and evidence-based recommendations. Crit Rev Oncol Hematol 2022; 171:103575. [PMID: 34968623 PMCID: PMC10658987 DOI: 10.1016/j.critrevonc.2021.103575] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 12/22/2022] Open
Abstract
Pharmacological strategies for chemotherapy-induced peripheral neurotoxicity (CIPN) are very limited. We systematically reviewed data on rehabilitation, exercise, physical therapy, and other physical non-pharmacological interventions and offered evidence-based recommendations for the prevention and treatment of CIPN. A literature search using PubMed, Web of Science and CINAHL was conducted from database inception until May 31st, 2021. 2791 records were title-abstract screened, 71 papers were full-text screened, 41 studies were included, 21 on prevention and 20 on treatment of CIPN. Treatment type, cancer type, chemotherapy compounds were heterogeneous, sample size was small (median: N = 34) and intention-to-treat analysis was lacking in 26/41 reports. Because of the methodological issues of included studies, the reviewed evidence should be considered as preliminary. Exercise, endurance, strength, balance, and sensorimotor training have been studied in low-to-moderate quality studies, while the evidence for other treatments is preliminary/inconclusive. We offer recommendation for the design of future trials on CIPN.
Collapse
Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Italy; IRCCS San Martino Hospital, Genoa, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Mehrnaz Hamedani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Italy
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Vesile Yildiz-Kabak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ian R Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Noah Kolb
- Department of Neurological Sciences, University of Vermont, Burlington, VT, USA
| | | | - Brendan L McNeish
- Department of Neurological Sciences, University of Vermont, Burlington, VT, USA
| | - Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
| | - Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ahmet Hoke
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
15
|
Recent advances in managing chemotherapy-induced peripheral neuropathy: A systematic review. Eur J Oncol Nurs 2022; 58:102134. [DOI: 10.1016/j.ejon.2022.102134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022]
|
16
|
Mezzanotte JN, Grimm M, Shinde NV, Nolan T, Worthen-Chaudhari L, Williams NO, Lustberg MB. Updates in the Treatment of Chemotherapy-Induced Peripheral Neuropathy. Curr Treat Options Oncol 2022; 23:29-42. [PMID: 35167004 PMCID: PMC9642075 DOI: 10.1007/s11864-021-00926-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT Chemotherapy-induced peripheral neuropathy (CIPN) is a common toxicity associated with treatment with platinum-based agents, taxanes, vinca alkaloids, and other specific agents. The long-term consequences of this condition can result in decreased patient quality of life and can lead to reduced dose intensity, which can negatively impact disease outcomes. There are currently no evidence-based preventative strategies for CIPN and only limited options for treatment. However, there are several strategies that can be utilized to improve patient experience and outcomes as more data are gathered in the prevention and treatment setting. Before treatment, patient education on the potential side effects of chemotherapy is key, and although trials have been limited, recommending exercise and a healthy lifestyle before and while undergoing chemotherapy may provide some overall benefit. In patients who develop painful CIPN, our approach is to offer duloxetine and titrate up to 60 mg daily. Chemotherapy doses may also need to be reduced if intolerable symptoms develop during treatment. Some patients may also try acupuncture and physical therapy to help address their symptoms, although this can be limited by cost, time commitment, and patient motivation. Additionally, data on these modalities are currently limited, as studies are ongoing. Overall, approaching each patient on an individual level and tailoring treatment options for them based on overall physical condition, their disease burden, goals of care and co-morbid health conditions, and willingness to trial different approaches is necessary when addressing CIPN.
Collapse
Affiliation(s)
- Jessica N. Mezzanotte
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Room 334B, Columbus, OH 43210
| | - Michael Grimm
- The Ohio State University Comprehensive Cancer Center, 460 W. 10th Avenue, Columbus, OH 43210
| | - Namrata V. Shinde
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Columbus, OH 43210
| | - Timiya Nolan
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH 43210
| | - Lise Worthen-Chaudhari
- Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, 480 Medical Center Drive, Dodd Hall, Suite 1060, Columbus, OH 43210
| | - Nicole O. Williams
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 1800 Cannon Drive, 1310K Lincoln Tower, Columbus, OH 43210
| | - Maryam B. Lustberg
- Smilow Cancer Hospital/Yale Cancer Center, 35 Park Street, New Haven, CT 06519
| |
Collapse
|
17
|
Tsai CH, Lin YH, Li YS, Ho TL, Hoai Thuong LH, Liu YH. Integrated Medicine for Chemotherapy-Induced Peripheral Neuropathy. Int J Mol Sci 2021; 22:ijms22179257. [PMID: 34502166 PMCID: PMC8430591 DOI: 10.3390/ijms22179257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of typical chemotherapeutics among cancer survivors. Despite the recent progress, the effective prevention and treatment strategies for CIPN remain limited. Better understanding of the pathogenesis of CIPN may provide new niches for developing a new ideal therapeutic strategy. This review summarizes the current understanding of CIPN and current recommendations along with completed/active clinical trials and aims to foster translational research to improve the development of effective strategies for managing CIPN.
Collapse
Affiliation(s)
- Chih-Hung Tsai
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan; (C.-H.T.); (Y.-H.L.); (Y.-S.L.)
- Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin 64041, Taiwan
| | - Yuan-Ho Lin
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan; (C.-H.T.); (Y.-H.L.); (Y.-S.L.)
- Department of Chinese Medicine of E-Da Cancer Hospital, Kaohsiung 82445, Taiwan
| | - Yung-Sheng Li
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan; (C.-H.T.); (Y.-H.L.); (Y.-S.L.)
- Department of Chinese Medicine of Jiannren Hospital, Kaohsiung 811504, Taiwan
| | - Trung-Loc Ho
- International Master’s Program of Biomedical Sciences, China Medical University, Taichun 40402, Taiwan; (T.-L.H.); (L.H.H.T.)
| | - Le Huynh Hoai Thuong
- International Master’s Program of Biomedical Sciences, China Medical University, Taichun 40402, Taiwan; (T.-L.H.); (L.H.H.T.)
| | - Yu-Huei Liu
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan; (C.-H.T.); (Y.-H.L.); (Y.-S.L.)
- Department of Medical Genetics and Medical Research, China Medical University Hospital, Taichung 40402, Taiwan
- Drug Development Center, China Medical University, Taichung 40402, Taiwan
- Correspondence: ; Tel.: +886-4-22052121 (ext. 2044)
| |
Collapse
|
18
|
Hunsberger JB, Rathee V, Smith TJ. Use of Scrambler Therapy in the Treatment of Amyloidosis Neuropathic Pain. J Palliat Med 2021; 24:1579-1581. [PMID: 34314620 DOI: 10.1089/jpm.2020.0786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Scrambler therapy (ST) is a relatively new neuromodulation technique that is useful in treatment of medication-resistant pain syndromes, including chemotherapy-induced peripheral neuropathy and other chronic pain syndromes. Amyloidosis commonly leads to peripheral neuropathy, and although the mechanism is unclear, it is possibly related to amyloid deposits on the nerve. Case Presentation: In this case presentation, we describe the novel use of ST for a patient with 13 years of neuropathic pain related to amyloidosis and worsened by chemotherapy. The patient reported bilateral hand pain with burning and aching and bilateral numbness on the soles of her feet. Her upper extremities were treated with 4 days of 40 minute ST treatment sessions providing reduction in her pain scores to zero. Discussion: Current therapy for amyloid peripheral neuropathy aims at treating the underlying condition, and then medical management with gabapentinoids. This is first case presentation showing successful treatment with ST.
Collapse
Affiliation(s)
- Joann B Hunsberger
- Pediatric Anesthesiology and Pediatric Pain Management, Division of Pediatric Anesthesiology, Department of Anesthesiology and CCM, Johns Hopkins Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Hospice and Palliative Medicine, Johns Hopkins Medical Institutions, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Vaishali Rathee
- Hospice and Palliative Medicine, Johns Hopkins Medical Institutions, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Thomas J Smith
- Section of Palliative Medicine, Division of General Internal Medicine, Johns Hopkins Medical Institutions, JHUSOM, Baltimore, Maryland, USA
| |
Collapse
|
19
|
Al Onazi MM, Yurick JL, Harris C, Nishimura K, Suderman K, Pituskin E, Chua N, McNeely ML. Therapeutic Ultrasound for Chemotherapy-Related Pain and Sensory Disturbance in the Hands and Feet in Patients With Colorectal Cancer: A Pilot Randomized Controlled Trial. J Pain Symptom Manage 2021; 61:1127-1138. [PMID: 33137422 DOI: 10.1016/j.jpainsymman.2020.10.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022]
Abstract
CONTEXT This proof-of-concept trial was undertaken as a first step in exploring the clinical benefit of therapeutic ultrasound for pain and sensory disturbance in patients with colorectal cancer. OBJECTIVES The aim of this study was to determine the feasibility and preliminary efficacy of adding therapeutic ultrasound to a home-based therapeutic exercise program (current standard of care) for patients presenting with oxaliplatin-related pain and sensory disturbance in the hands and feet. METHODS Thirty-one colorectal cancer patients with presenting symptoms of peripheral sensory neuropathy, based on a physician-rated grade 1, 2, or 3 on the National Cancer Institute Common Terminology Criteria for Adverse Events for sensory and motor neuropathy, were enrolled in the trial. Patients were randomized to either 10 sessions of ultrasound therapy intervention over two-week period (continuous ultrasound at an intensity of 0.7 to 0.8 w/cm2, and frequency of 3 MHz for 5 minutes) plus standard care (n = 16) or to standard care alone (n = 15). The feasibility of therapeutic ultrasound was determined by the recruitment rate, participants' adherence to the intervention, and the study completion rates. Assessments of pain, sensory disturbance, sensation, and balance were conducted at baseline, two and six weeks. RESULTS We achieved a recruitment rate of 84%, an adherence rate of 100% to the intervention, and a completion rate of 100%. Adding therapeutic ultrasound to standard care resulted in a statistically and clinically significant improvement in symptoms of pain and sensory disturbance (P = 0.003) at two weeks; however, no significance difference between the groups was found at the six-week follow-up. CONCLUSIONS The findings of this proof-of-concept study support the feasibility of the therapeutic ultrasound in addition to standard care as an intervention for colorectal cancer patients with oxaliplatin-related pain and sensory disturbance in the hands and feet. The findings warrant a large-scale placebo-controlled trial.
Collapse
Affiliation(s)
- Mona M Al Onazi
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Janice L Yurick
- Department of Rehabilitation Medicine, Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Claire Harris
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Kacy Nishimura
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Kirsten Suderman
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Edith Pituskin
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Department of Oncology, Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Neil Chua
- Department of Oncology, Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Margaret L McNeely
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada; Department of Rehabilitation Medicine, Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada.
| |
Collapse
|
20
|
Differential response to scrambler therapy by neuropathic pain phenotypes. Sci Rep 2021; 11:10148. [PMID: 33980957 PMCID: PMC8115242 DOI: 10.1038/s41598-021-89667-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/27/2021] [Indexed: 12/19/2022] Open
Abstract
Scrambler therapy is a noninvasive electroanalgesia technique designed to remodulate the pain system. Despite growing evidence of its efficacy in patients with neuropathic pain, little is known about the clinical factors associated with treatment outcome. We conducted a prospective, open-label, single-arm trial to assess the efficacy and safety of scrambler therapy in patients with chronic neuropathic pain of various etiologies. A post-hoc analysis was performed to investigate whether cluster analysis of the Neuropathic Pain Symptom Inventory (NPSI) profiles could identify a subgroup of patients regarding neuropathic pain phenotype and treatment outcome. Scrambler therapy resulted in a significant decrease in the pain numerical rating scale (NRS) score over 2 weeks of treatment (least squares mean of percentage change from baseline, − 15%; 95% CI − 28% to − 2.4%; p < 0.001). The mean score of Brief Pain Inventory (BPI) interference subdimension was also significantly improved (p = 0.022), while the BPI pain composite score was not. Hierarchical clustering based on the NPSI profiles partitioned the patients into 3 clusters with distinct neuropathic pain phenotypes. Linear mixed-effects model analyses revealed differential response to scrambler therapy across clusters (p = 0.003, pain NRS; p = 0.072, BPI interference subdimension). Treatment response to scrambler therapy appears different depending on the neuropathic pain phenotypes, with more favorable outcomes in patients with preferentially paroxysmal pain rather than persistent pain. Further studies are warranted to confirm that capturing neuropathic pain phenotypes can optimize the use of scrambler therapy.
Collapse
|
21
|
The Role of Nucleotide Excision Repair in Cisplatin-Induced Peripheral Neuropathy: Mechanism, Prevention, and Treatment. Int J Mol Sci 2021; 22:ijms22041975. [PMID: 33671279 PMCID: PMC7921932 DOI: 10.3390/ijms22041975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 02/06/2023] Open
Abstract
Platinum-based chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common dose-limiting effects of cancer treatment and results in dose reduction and discontinuation of life-saving chemotherapy. Its debilitating effects are often permanent and lead to lifelong impairment of quality of life in cancer patients. While the mechanisms underlying the toxicity are not yet fully defined, dorsal root ganglia sensory neurons play an integral role in symptom development. DNA-platinum adducts accumulate in these cells and inhibit normal cellular function. Nucleotide excision repair (NER) is integral to the repair of platinum adducts, and proteins involved in its mechanism serve as potential targets for future therapeutics. This review aims to highlight NER’s role in cisplatin-induced peripheral neuropathy, summarize current clinical approaches to the toxicity, and discuss future perspectives for the prevention and treatment of CIPN.
Collapse
|
22
|
Jordan B, Margulies A, Cardoso F, Cavaletti G, Haugnes HS, Jahn P, Le Rhun E, Preusser M, Scotté F, Taphoorn MJB, Jordan K. Systemic anticancer therapy-induced peripheral and central neurotoxicity: ESMO-EONS-EANO Clinical Practice Guidelines for diagnosis, prevention, treatment and follow-up. Ann Oncol 2020; 31:1306-1319. [PMID: 32739407 DOI: 10.1016/j.annonc.2020.07.003] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- B Jordan
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
| | - A Margulies
- European Oncology Nursing Society, Brussels, Belgium
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - G Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsoe, Norway; Institute of Medicine, UIT - The Arctic University, Tromsoe, Norway
| | - P Jahn
- University of Halle, Nursing Research Unit, Halle, Germany
| | - E Le Rhun
- University of Lille, Inserm, U-1192, Lille, France; CHU Lille, Neuro-oncology, General and Stereotaxic Neurosurgery Service, Lille, France; Breast Cancer Department, Oscar Lambret Center, Lille cedex, France; Department of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - M Preusser
- Clinical Division of Oncology, Comprehensive Cancer Center CNS Tumours Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - F Scotté
- Gustave Roussy Cancer Campus, Interdisciplinary Cancer Course Department, Villejuif, France
| | - M J B Taphoorn
- Department of Neurology, Leiden University Medical Center and Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
23
|
Loprinzi CL, Lacchetti C, Bleeker J, Cavaletti G, Chauhan C, Hertz DL, Kelley MR, Lavino A, Lustberg MB, Paice JA, Schneider BP, Lavoie Smith EM, Smith ML, Smith TJ, Wagner-Johnston N, Hershman DL. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update. J Clin Oncol 2020; 38:3325-3348. [PMID: 32663120 DOI: 10.1200/jco.20.01399] [Citation(s) in RCA: 555] [Impact Index Per Article: 111.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To update the ASCO guideline on the recommended prevention and treatment approaches in the management of chemotherapy-induced peripheral neuropathy (CIPN) in adult cancer survivors. METHODS An Expert Panel conducted targeted systematic literature reviews to identify new studies. RESULTS The search strategy identified 257 new references, which led to a full-text review of 87 manuscripts. A total of 3 systematic reviews, 2 with meta-analyses, and 28 primary trials for prevention of CIPN in addition to 14 primary trials related to treatment of established CIPN, are included in this update. RECOMMENDATIONS The identified data reconfirmed that no agents are recommended for the prevention of CIPN. The use of acetyl-l-carnitine for the prevention of CIPN in patients with cancer should be discouraged. Furthermore, clinicians should assess the appropriateness of dose delaying, dose reduction, substitutions, or stopping chemotherapy in patients who develop intolerable neuropathy and/or functional impairment. Duloxetine is the only agent that has appropriate evidence to support its use for patients with established painful CIPN. Nonetheless, the amount of benefit from duloxetine is limited.Additional information is available at www.asco.org/survivorship-guidelines.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Mark R Kelley
- Indiana University School of Medicine, Indianapolis, IN
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Gordon-Williams R, Farquhar-Smith P. Recent advances in understanding chemotherapy-induced peripheral neuropathy. F1000Res 2020; 9. [PMID: 32201575 PMCID: PMC7076330 DOI: 10.12688/f1000research.21625.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 12/20/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common cause of pain and poor quality of life for those undergoing treatment for cancer and those surviving cancer. Many advances have been made in the pre-clinical science; despite this, these findings have not been translated into novel preventative measures and treatments for CIPN. This review aims to give an update on the pre-clinical science, preventative measures, assessment and treatment of CIPN.
Collapse
Affiliation(s)
- Richard Gordon-Williams
- Department of Pain Medicine, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Paul Farquhar-Smith
- Department of Pain Medicine, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| |
Collapse
|
25
|
Kachrani R, Santana A, Rogala B, Pawasauskas J. Chemotherapy-Induced Peripheral Neuropathy: Causative Agents, Preventative Strategies, and Treatment Approaches. J Pain Palliat Care Pharmacother 2020; 34:141-152. [DOI: 10.1080/15360288.2020.1734144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Rishi Kachrani
- Rishi Kachrani, PharmD Candidate is in the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA; Anthony Santana, PharmD Candidate is in the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA; Britny Rogala, PharmD, BCOP is in the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA; Department of Pharmacy, Women & Infants Hospital,
| | - Anthony Santana
- Rishi Kachrani, PharmD Candidate is in the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA; Anthony Santana, PharmD Candidate is in the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA; Britny Rogala, PharmD, BCOP is in the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA; Department of Pharmacy, Women & Infants Hospital,
| | - Britny Rogala
- Rishi Kachrani, PharmD Candidate is in the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA; Anthony Santana, PharmD Candidate is in the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA; Britny Rogala, PharmD, BCOP is in the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA; Department of Pharmacy, Women & Infants Hospital,
| | - Jayne Pawasauskas
- Rishi Kachrani, PharmD Candidate is in the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA; Anthony Santana, PharmD Candidate is in the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA; Britny Rogala, PharmD, BCOP is in the Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA; Department of Pharmacy, Women & Infants Hospital,
| |
Collapse
|
26
|
Baute V, Zelnik D, Curtis J, Sadeghifar F. Complementary and Alternative Medicine for Painful Peripheral Neuropathy. Curr Treat Options Neurol 2019; 21:44. [DOI: 10.1007/s11940-019-0584-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
27
|
Sanft T, Denlinger CS, Armenian S, Baker KS, Broderick G, Demark-Wahnefried W, Friedman DL, Goldman M, Hudson M, Khakpour N, Koura D, Lally RM, Langbaum TS, McDonough AL, Melisko M, Mooney K, Moore HCF, Moslehi JJ, O'Connor T, Overholser L, Paskett ED, Peterson L, Pirl W, Rodriguez MA, Ruddy KJ, Smith S, Syrjala KL, Tevaarwerk A, Urba SG, Zee P, McMillian NR, Freedman-Cass DA. NCCN Guidelines Insights: Survivorship, Version 2.2019. J Natl Compr Canc Netw 2019; 17:784-794. [PMID: 31319383 PMCID: PMC7094216 DOI: 10.6004/jnccn.2019.0034] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for consequences of cancer and cancer treatment to aid healthcare professionals who work with survivors of adult-onset cancer. Guidance is also provided to help promote physical activity, weight management, and proper immunizations in survivors and to facilitate care coordination to ensure that all needs are addressed. These NCCN Insights summarize some of the topics discussed by the NCCN Survivorship Panel during the 2019 update of the guidelines, including the survivorship population addressed, ways to improve care coordination, and pain management.
Collapse
Affiliation(s)
- Tara Sanft
- Yale Cancer Center/Smilow Cancer Hospital
| | | | | | - K Scott Baker
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | - Mindy Goldman
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Melissa Hudson
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | | | - Kathi Mooney
- Huntsman Cancer Institute at the University of Utah
| | - Halle C F Moore
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Lindsay Peterson
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Phyllis Zee
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University; and
| | | | | |
Collapse
|