Bortezomib-induced peripheral neuropathy (BIPN) is a common and debilitating side effect. Our pilot study demonstrated that acupuncture is safe and can decrease total neuropathic symptoms. However, there is lack of knowledge in which individual BIPN symptoms benefited from acupuncture.
To characterize individual symptoms reduced by acupuncture in patients with BIPN.
Patients with multiple myelomatreated with bortezomib who developed BIPN grade 2 or above, based on National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), were enrolled and received 10 acupuncture treatments over 10 weeks. Self-reported BIPN-associated symptoms assessments were collected weekly at baseline, during, and after acupuncture treatment using the Neuropathy Pain Scale (NPS) and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) questionnaires. Changes in individual symptoms were analyzed based on FACT/GOG-Ntx and NPS scores.
All patients received 10 acupuncture treatments: twice weekly for the first 2 weeks, weekly for 4 weeks, and then biweekly for 4 weeks. The acupuncture treatments were performed by a licensed acupuncturist with 8 years of experience. All acupuncture points were selected for their analgesic characteristics and effectiveness in treating pain, swelling, and numbness (Yin Yang House, 2013). Points included bilateral ear points (Shen men, point zero, and 2 additional auricular acupuncture points where electrodermal signal was detected), bilateral body acupuncture points (LI4, TE5, LI11, ST40), and Ba Feng located in upper and lower extremities were selected, and procedures were described in detail in our previous publication.11 The de qi, a sense of aching pain, soreness, and heaviness, was achieved in certain acupuncture points (LI4, LI11, and ST40). All patients continued their previously prescribed peripheral neuropathy medications and were encouraged to avoid any changes for the duration of the study.
There were statistically significant reductions in individual symptoms in both NPS and FACT/GOG-Ntx. The FACT/GOG-Ntx reductions were most pronounced in hand/feet numbness/tingling, discomfort, and trouble walking. The sensory symptoms, such as tingling and numbness, especially in the feet, reduced the most ( P < .0001), and motor dysfunction also reduced significantly ( P = .0001). Both hearing and dysfunction scores were also statistically significantly increased, indicating improved symptoms. The NPS scores showed significant symptom relief in all 10 items from the NPS assessment, particularly in cold sensitivity and an unpleasant feeling.
Acupuncture can improve multiple symptoms associated with BIPN, particularly numbness and tingling in hands and feet, cold sensitivity, and an unpleasant feeling. Further randomized control trials are warranted to confirm our findings.
Authors: Zhi WI, Ingram E, Li SQ, Chen P, Piulson L, Bao T
Published in: Integr Cancer Ther. 2018 Jul 1:1534735418788667