CIPN 2019

Inspired by Molassiotis et al Integr Cancer Ther 2019.[1]

Chemotherapy-Induced Peripheral Neuropathy

CIPN

Photo by Alexander Krivitskiy on Unsplash.

This is the first fully powered RCT of acupuncture in CIPN

This is the first fully powered RCT of acupuncture in CIPN (chemotherapy-induced peripheral neuropathy). Alex Molassiotis is an academic from a nursing background who worked at The Christie in Manchester for some years. Whilst there he ran a variety of projects involving acupuncture and acupressure,[2–6] and has a couple of papers published in Acupuncture in Medicine.[7,8]

This is a medium-sized study with n=87 randomised to two arms, and the design is similar to the ARC studies of the Modellvorhaben Akupunktur.[9] The waiting list control group were offered acupuncture at the end of the trial (20 weeks). Treatment involved two sessions per week for 8 weeks and the primary outcome was worst pain intensity on the BPI (Brief Pain Inventory) at 8 weeks.

A standardised approach was used, but with some flexibility depending on the sensitivity of the patient. The study was performed in Hong Kong where Alex is now based. Chinese needles were used of 0.25mm diameter. The methods record the following about the points used:

The points were standardized according to the clinical manifestations of the subjects: if upper limbs were involved, we used LI4, LI11, PC7, TE5, and/or Baxie points (Ex-UE9; since the effect of Ex-UE9, PC7, and TE5 are similar, only 1 out of the 3 was chosen); if lower limbs were affected (most common), we used SP6, ST36, LR3, ST41, and/or Bafeng (Ex-LE10; since the effect of LR3, Ex-LE10, and ST41 are similar, only 1 out of the 3 was chosen)…

[LV changed to LR in text by MC]

Molassiotis et al Integr Cancer Ther 2019.[1]

If the pain threshold of the patients was low, TE5 for upper limbs and/or ST41 for lower limbs were chosen.

Molassiotis et al Integr Cancer Ther 2019.[1]

I like the choice based on the individual sensitivity, although I would not choose to use 0.25mm diameter needles in the hands and feet. I prefer to use 0.16mm smooth Japanese needles in these areas.

The primary outcome showed a significant change from baseline in the treatment group, although not a significant between group difference. The effect wore off to some degree by 14 and 20 weeks in the treatment group but did not reach baseline, whereas the waiting list group deteriorated over the study period.

Looking at the graphs of the results, the effect of acupuncture does not seem wholly convincing, but this sample of patients had finished their chemotherapy over a year before on average, so the CIPN was established. My experience of late is using acupuncture during chemotherapy to prevent onset of CIPN or reverse the very early emergence of symptoms.

What about prophylactic use in high risk groups?

MC

But this is a start, and hopefully it can lead to further use and evaluation of the technique, and even prophylactic use in high risk groups.

References

1         Molassiotis A, Suen LKP, Cheng HL, et al. A Randomized Assessor-Blinded Wait-List-Controlled Trial to Assess the Effectiveness of Acupuncture in the Management of Chemotherapy-Induced Peripheral Neuropathy. Integr Cancer Ther 2019;18:1534735419836501. doi:10.1177/1534735419836501

2         Molassiotis A, Bardy J, Finnegan-John J, et al. Acupuncture for Cancer-Related Fatigue in Patients With Breast Cancer: A Pragmatic Randomized Controlled Trial. J Clin Oncol 2012;30:4470–6. doi:10.1200/JCO.2012.41.6222

3         Molassiotis A, Bardy J, Finnegan-John J, et al. A randomized, controlled trial of acupuncture self-needling as maintenance therapy for cancer-related fatigue after therapist-delivered acupuncture. Ann Oncol 2013;24:1645–52. doi:10.1093/annonc/mdt034

4         Molassiotis A, Russell W, Hughes J, et al. The Effectiveness of Acupressure for the Control and Management of Chemotherapy-Related Acute and Delayed Nausea: A Randomized Controlled Trial. J Pain Symptom Manage 2014;47:12–25. doi:10.1016/j.jpainsymman.2013.03.007

5         Molassiotis A, Russell W, Hughes J, et al. The effectiveness and cost-effectiveness of acupressure for the control and management of chemotherapy-related acute and delayed nausea: Assessment of Nausea in Chemotherapy Research (ANCHoR), a randomised controlled trial. Heal Technol Assess 2013;17:1–114. doi:10.3310/hta17260

6         Yorke J, Lloyd-Williams M, Smith J, et al. Management of the respiratory distress symptom cluster in lung cancer: a randomised controlled feasibility trial. Support Care Cancer 2015;23:3373–84. doi:10.1007/s00520-015-2810-x

7         Molassiotis A. Managing Cancer-Related Fatigue with Acupuncture: Is it all Good News for Patients? Acupunct Med 2013;31:3–4. doi:10.1136/acupmed-2012-010292

8         Bardy J, Mackereth P, Finnegan-John J, et al. Training in Self-Needling and Performing it as Part of a Clinical Trial: The Practitioner and Patient Experience. Acupunct Med 2015;33:210–6. doi:10.1136/acupmed-2014-010708

9         Cummings M. Modellvorhaben Akupunktur–a summary of the ART, ARC and GERAC trials. Acupunct Med 2009;27:26–30. doi:10.1136/aim.2008.000281


Declaration of interests MC