Inspired by Ter et al 2026.[1]
CIPN – chemotherapy-induced peripheral neuropathy
EA – electroacupuncture
MSKCC – Memorial Sloan Kettering Cancer Center
CTCAE – common terminology criteria for adverse events (from the US NCI)
NCI – National Cancer Institute (US)
ADLs – activities of daily living
MA – manual acupuncture
NPSI – neuropathic pain symptom inventory
VAS – visual analogue scale
FACT – functional assessment of cancer therapy (in this case FACT-Taxane V4)– key to acronyms
This paper was first published online in January, and I have been waiting for it to be page set before presenting it here. It is another relatively small trial (n=60) of acupuncture in CIPN. The last paper I highlighted on CIPN was in 2024, but that was an experimental study (see EA astrocytes and CIPN 2024). The last time we saw a clinical trial in humans was back in 2022 (see EA for CIPN 2022).
This will be the 10th entry in the CIPN category on this blog.
I am still waiting to see the results of a much larger (n=250) trial underway at MSKCC looking at the use of EA in the treatment of pain related to CIPN. The trial was due to be completed at the end of April this year, so we will have to wait a little longer for the report. I will certainly highlight it here when it is published, but in the meantime, let’s have a look at this smaller offering.
This paper comes from a cancer centre in Sao Paulo, Brazil, and is published in the journal Supportive Care in Cancer (IF 3.0), the first issue of which was published in January 1993.
The patients recruited to the trial were all women with breast cancer (stages I, II, or III) who had received adjuvant or neoadjuvant chemotherapy with paclitaxel (80mg/m2) and developed CIPN of grade 2 or 3 on CTCAE, which is moderate to severe and affecting ADLs.
The women were randomised to receive either true MA or a superficial off-point sham. The points used in the true MA group were Baxie, TE5, LI4 in the upper limbs and Bafeng, KI3, ST36 in the lower limbs, which I make to be 6 needle insertions in each limb. The needles used were Korean 0.20x30mm. My reading of the methods suggests that in the sham group they used 3 superficial needle insertions in the same segments of each limb with the same needles.
Treatment was performed once a week for 8 weeks and outcomes were assessed in person at 1, 4, 6, and 8 weeks, and by telephone at 12 weeks.
The primary outcome measure was the NPSI total score, and I guess the primary endpoint was meant to be at the end of the treatment phase although this was not stated. Secondary outcomes were VAS (CIPN symptoms) and FACT-taxane.
At week 8, there was a significant difference in the NPSI total score in favour of the true MA group (p=0.02). At 12 weeks this difference had disappeared. So, if they had meant for the 8-week total score to be the primary outcome, then this would be a positive result. Unfortunately, they do not clearly state this, and they performed 30 different probability tests on the NPSI scores alone. Whilst they mention using the Bonferroni method, it is not clear that there was any adjustment of the p value to account for multiple testing.
VAS scores also showed a significant difference at week 8, but again this disappeared at week 12. There were no differences to be found in the FACT-taxane scores.
This was a small study of needling versus needling with only 8 sessions and a 20% dropout. Despite this there are one or two signals of an acupuncture effect by the end of the treatment cycle, but this does not persist.
Other research suggests that acupuncture can have an effect on nerve function, so it could be that you need to perform enough acupuncture to facilitate recovery of nerve function and minimise symptoms before stopping, otherwise there is a risk of reamplification of the residual symptoms (especially the dysaesthesia). I will lay out my personal ideas further on Wednesday, but we do need some bigger trials in CIPN.
References
1 Ter LI, Yamada AMTD, do Nascimento Martins Basilio A, et al. Acupuncture for peripheral neuropathy induced by paclitaxel in early-stage breast cancer: a randomized, parallel, controlled, blinded study in a Brazilian Oncologic Center (PACLILIN Study). Support Care Cancer. 2026;34:102. doi: 10.1007/s00520-026-10315-8
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