Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of neurotoxic chemotherapy. It may present as numbness, tingling, burning pain, altered sensation, or weakness, typically affecting the hands and feet. Symptoms can persist after chemotherapy and may impact daily function and quality of life.
Acupuncture has been investigated as a non-pharmacological approach for CIPN in several randomised controlled trials (RCTs). The findings to date are mixed and remain inconclusive.
Randomised Controlled Trials
A randomised clinical trial published in JAMA Network Open compared acupuncture, sham acupuncture, and usual care in cancer survivors with persistent CIPN. After 8 weeks, acupuncture was associated with greater improvement compared to usual care, but differences between acupuncture and sham acupuncture were small. The authors described the findings as preliminary.
A pilot randomised sham-controlled trial in patients receiving taxane chemotherapy reported changes in neuropathic symptoms and sensory thresholds. As a pilot study with a small sample size, the results are not definitive.
A 2023 randomised, sham-controlled study in patients receiving oxaliplatin-based chemotherapy reported differences in CIPN severity and sensory measures between groups. However, interpretation is limited by study design, population specificity, and variability in outcome measures.
A mixed-methods pilot study in an integrative oncology setting assessed feasibility and patient experience rather than clinical effectiveness.
Interpretation of Evidence
Across RCTs, acupuncture has been studied for both prevention and treatment of CIPN. Outcomes have included symptom scores, pain measures, quality of life, and sensory testing.
Results are inconsistent. Some studies report improvements compared to usual care, while differences between acupuncture and sham controls are often small or unclear. Sample sizes are frequently limited, and treatment protocols vary.
Current evidence does not provide consistent or high-certainty support for acupuncture as an effective treatment for CIPN.
Clinical Context
The 2020 American Society of Clinical Oncology (ASCO) guideline states that duloxetine is the only pharmacological treatment with moderate-quality evidence that may be offered for painful CIPN.
For non-pharmacological approaches, including acupuncture, the guideline concludes that evidence is insufficient to make a recommendation for or against their use.
Acupuncture has been studied as a supportive care option, but its role remains uncertain and should be considered within an individualised clinical context.
References
Bao, T., Patil, S., Chen, C., Zhi, I. W., Li, Q. S., Piulson, L., et al. (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
Huang, C. C., Ho, T. J., Ho, H. Y., Chen, P. Y., Tu, C. H., Huang, Y. C., et al. (2021). Acupuncture relieved chemotherapy-induced peripheral neuropathy in patients with breast cancer: A pilot randomized sham-controlled trial. Journal of Clinical Medicine, 10(16), 3694. https://doi.org/10.3390/jcm10163694
Huang, M. C., Chang, S. C., Liao, W. L., Ke, T. W., Lee, A. L., Wang, H. M., Chang, C. P., Yen, H. R., Chang, H. H., & Chen, W. T. (2023). Acupuncture may help to prevent chemotherapy-induced peripheral neuropathy: A randomized, sham-controlled, single-blind study. The Oncologist, 28(6), e436–e447. https://doi.org/10.1093/oncolo/oyad065
Lagerstedt, K., & Efverman, A. (2023). A randomized sham-controlled mixed methods pilot study of the feasibility of acupuncture for chemotherapy-induced neuropathy: Lessons learned from patient experiences in integrative cancer care. Integrative Cancer Therapies, 22, 15347354231178877. https://doi.org/10.1177/15347354231178877
Loprinzi, C. L., Lacchetti, C., Bleeker, J., et al. (2020). Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO guideline update. Journal of Clinical Oncology, 38(28), 3325–3348. https://doi.org/10.1200/JCO.20.01399