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New UK research confirms acupuncture benefits for chemotherapy induced peripheral neuropathy

New UK research confirms acupuncture benefits for chemotherapy induced peripheral neuropathy

In this month's blog, the British Acupuncture Council's head of research, Mark Bovey, takes an in-depth look at research that came out in December 2019 on the effectiveness of acupuncture for the treatment of chemotherapy induced peripheral neuropathy

On 28 December 2019 The Christie NHS Trust in Manchester reported very positively on their trial of acupuncture for chemotherapy induced peripheral neuropathy (CIPN) https://www.christie.nhs.uk/about-us/news/latest-news-stories/christie-research-shows-acupuncture-helps-chemo-patients . Dr Jacqui Stringer, lead for complementary health and wellbeing described the results as ‘phenomenal’. A patient told how she was now able to drive again and return to embroidery, things she’d had to give up because of the nerve symptoms. CIPN is a common side effect of chemotherapy treatment, and may show both sensory symptoms (e.g. tingling, over-sensitivity, pain), motor symptoms (impaired movements and activities) and overall a reduced quality of life. Chief investigator and consultant oncologist professor Andrew Wardley: ‘We hope this trial will lead to a new standard of care for treating this condition, improving the lives of millions of patients’. Even without this recent endorsement acupuncture is used by many people with CIPN (30% in one survey).

The Christie study, with 120 participants, is the largest to date for acupuncture and CIPN.  68% of patients in the acupuncture group (acupuncture plus standard care) had improved dexterity and mobility compared with only 33% in the control (standard care alone). So far we have only the press release, not a published paper, so we can’t examine the results in detail, but this study does appear to enhance findings from previous research. Most of the existing randomised controlled trials (RCTs) in this area have been published in the last five years, with three in 2019 alone. The most recent systematic review came out at the end of last year and includes six high quality RCTs with 386 patients in total (Chien 2019) https://www.ncbi.nlm.nih.gov/pubmed/31833790. This found acupuncture to be an effective treatment for CIPN pain and functional limitations, but the small number and size of the trials does limit the strength of the conclusion. In this respect the larger Christie study will be a valuable addition.

In the review’s meta-analysis acupuncture was associated with highly statistically significant improvements in both pain intensity and neurological symptoms. There is considerable scientific debate on how to assess the clinical importance of such data (will patients notice the difference? Will it be valuable to the NHS?) but on the face of it the 68% vs 33% response rate picture in the Christie trial looks pretty useful. Note too that this was achieved with patients with more severe symptoms (≥grade II CIPN).

Altogether there is much variation across studies in numerous important characteristics, including CIPN severity but also the length and accumulated dose of chemotherapy, the chemotherapy agent, the number and frequency of acupuncture treatment sessions, the identity and number of the acupuncture points and whether they were entirely standardised, the possible use of electroacupuncture, the orthodox care delivered alongside the acupuncture, and the nature of the control group. Much work remains to be done to determine which patients would most benefit and the best way to deliver the treatment.

Nevertheless, with limited, poorly evidenced conventional options for CIPN, acupuncture should be a strong candidate for helping people with this debilitating condition. Not least, it has a good safety record in general and no significant adverse events reported in the CIPN studies to date.

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