Chemotherapy Induced Peripheral Neuropathy

Written By Georgios Vlahoylis

Clinical Trials & Acupuncture Integration

Can Acupuncture Help with Nerve Pain After Chemotherapy? #1

Did you know that people undergoing chemotherapy with drugs like paclitaxel, oxaliplatin, or bortezomib, frequently experience a lingering numbness or tingling in the fingers and toes that doesn't fully go away once treatment ends. This is called chemotherapy-induced peripheral neuropathy, or CIPN, and it's one of the most common and most under-treated long-term effects of cancer care.

CIPN happens when certain chemotherapy drugs damage peripheral nerves, the nerves that run from your spinal cord out to your hands and feet. Symptoms typically show up as numbness, tingling, burning, or pain, usually starting in the fingers and toes and sometimes spreading further.

It's common, and it can be long-lasting. Research shows roughly two-thirds of patients still have symptoms one month after finishing chemotherapy, and about 3 in 10 still have symptoms six months or more later. Beyond the discomfort, CIPN can affect grip strength, balance, and walking, which raises the risk of falls and can quietly limit day-to-day independence.

Treatment options remain limited. Currently, the only medication formally recommended by the American Society of Clinical Oncology for painful CIPN is duloxetine, an antidepressant that can also help with nerve pain. It doesn't work for everyone, and it comes with its own side effects, including fatigue, sleep trouble, and digestive upset. This treatment gap is exactly where a growing body of acupuncture research has focused its attention.

How the Research Developed

Acupuncture for CIPN hasn't been tested in just one study. Researchers at a major U.S. cancer center have built an evidence base over roughly a decade, with each trial designed to answer questions the last one couldn't:

  • Early pilot work (2014). A small first study tested acupuncture for neuropathy caused by bortezomib, a chemotherapy drug used for multiple myeloma. It established that acupuncture was safe and feasible for this population, and that symptoms tended to improve.

  • Treating neuropathy as it develops (2018). A trial in breast cancer patients receiving weekly paclitaxel tested whether acupuncture given during chemotherapy, not just afterward, could reduce how severe neuropathy became.

  • A rigorous, placebo-controlled trial (2020). Published in JAMA Network Open, this study was the first CIPN acupuncture trial to compare real acupuncture against both a sham (placebo) acupuncture procedure and a group receiving no intervention at all. This design matters because it helps separate acupuncture's actual physiological effect from the effect of attention, ritual, and expectation.

  • Looking beyond pain scores (2021). Using data from the same trial, researchers examined how acupuncture affected everyday function, sleep, and anxiety, not just the numbness, tingling, and pain scores.

  • Larger, multi-site trials (2023–2024, ongoing). Building on these earlier results, larger Phase III trials are now underway, including one testing acupuncture as a treatment for existing CIPN and an international trial testing whether acupuncture can help prevent CIPN from developing in the first place during taxane-based chemotherapy.

What the 2020 Trial Found

This trial enrolled 75 cancer survivors with moderate-to-severe CIPN, most of them years out from breast or colorectal cancer treatment. Participants were randomly assigned to one of three groups for eight weeks: real acupuncture, sham (placebo) acupuncture, or usual care with no intervention.

Symptoms were rated on a 0-to-10 scale, where 0 means no symptoms and 10 means the worst symptoms imaginable. By the end of the eight weeks, compared with the usual-care group, real acupuncture produced meaningful improvement across all three core CIPN symptoms:

  • Pain dropped by about 1.75 points with real acupuncture, compared to almost no change with usual care.

  • Tingling dropped by about 1.83 points with real acupuncture, compared to almost no change with usual care.

  • Numbness dropped by about 1.54 points with real acupuncture, while the usual-care group's numbness slightly worsened.

These improvements were still present a month after treatment ended, which suggests the benefit wasn't simply the result of regular visits and attention during the treatment period itself.

stay tuned in for part #2….

References

Bao, T., Goloubeva, O., Pelser, C., Porter, N., Primrose, J., Hester, L., ... & Edwards, T. (2014). A pilot study of acupuncture in treating bortezomib-induced peripheral neuropathy in patients with multiple myeloma. Integrative Cancer Therapies, 13(5), 396–404. https://doi.org/10.1177/1534735414534729

Bao, T., Seidman, A. D., Piulson, L., Vertosick, E., Chen, X., Vickers, A. J., ... & Mao, J. J. (2018). A phase IIA trial of acupuncture to reduce chemotherapy-induced peripheral neuropathy severity during neoadjuvant or adjuvant weekly paclitaxel chemotherapy in breast cancer patients. European Journal of Cancer, 101, 12–19. https://doi.org/10.1016/j.ejca.2018.06.008

Bao, T., Patil, S., Chen, C., Zhi, I. W., Li, Q. S., Piulson, L., & Mao, J. J. (2020). Effect of acupuncture vs sham procedure on chemotherapy-induced peripheral neuropathy symptoms: A randomized clinical trial. JAMA Network Open, 3(3), e200681. https://doi.org/10.1001/jamanetworkopen.2020.0681

Bao, T., Baser, R., Chen, C., Weitzman, M., Zhang, Y. L., Seluzicki, C., Li, Q. S., Piulson, L., & Zhi, W. I. (2021). Health-related quality of life in acupuncture for chemotherapy-induced peripheral neuropathy: A randomized trial. The Oncologist, 26(11), e2070–e2078. https://doi.org/10.1002/onco.13936

Chiang, C., Han, K., Piulson, L., Seluzicki, C., Weitzman, M., Zhang, Y. L., Zhi, I., & Bao, T. (2023). A randomized phase III clinical trial of acupuncture for chemotherapy-induced peripheral neuropathy in survivors of cancer. Journal of Clinical Oncology, 41(16_suppl), TPS12144. https://doi.org/10.1200/JCO.2023.41.16_suppl.TPS12144

Giobbie-Hurder, A., Tanasijevic, A., Baedorf Kassis, S., Diederich, E., Sahraoui, A., Park, S. H., ... & Ligibel, J. A. (2024). Preventing chemotherapy-induced peripheral neuropathy with acupuncture, a multinational parallel randomized controlled trials project (PACT). Journal of Clinical Oncology, 42(16_suppl), TPS12156. https://doi.org/10.1200/JCO.2024.42.16_suppl.TPS12156

Hershman, D. L., Lacchetti, C., Dworkin, R. H., Lavoie Smith, E. M., Bleeker, J., Cavaletti, G., ... & American Society of Clinical Oncology. (2014). Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology, 32(18), 1941–1967. https://doi.org/10.1200/JCO.2013.54.0914

Yang, M., Lopez-Nieves, I., Tanasijevic, A., Piulson, L., Shrivastava, M., Weitzman, M., Zhi, I., Mao, J. J., & Bao, T. (2024). A randomized phase III clinical trial of acupuncture for chemotherapy-induced peripheral neuropathy treatment (ACT). Journal of Clinical Oncology, 42(16_suppl), TPS12151. https://doi.org/10.1200/JCO.2024.42.16_suppl.TPS12151

 

This blog is intended for educational purposes and does not replace individualized medical advice. Please discuss any new treatment approach with your oncology and acupuncture care team.

 

Georgios Vlahoylis
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