A Narrative Review of the Efficacy of Acupuncture in Chemotherapy-Induced Peripheral Neuropathy in Cancer Patients

This narrative review examines the efficacy of acupuncture in the treatment of chemotherapy-induced peripheral neuropathy (CIPN), a debilitating complication affecting 19-85% of oncology patients. CIPN manifests as pain, numbness, and tingling in the extremities, significantly impacting quality of life and potentially leading to reduced chemotherapy doses or treatment discontinuation. The authors analyzed 19 randomized controlled trials enrolling 1,174 participants, showing that acupuncture provides significant improvements in CIPN symptoms compared with conventional medications such as duloxetine and gabapentin. The methodology included searches of major databases for studies published through 2024, focusing on the impact of acupuncture on pain relief, neurologic function, and quality of life.

Proposed mechanisms of action involve modulation of endogenous opioids, particularly β-endorphins and enkephalins that bind to μ- and δ-opioid receptors, in addition to regulation of neurotransmitters such as serotonin and dopamine. Acupuncture also activates brain-derived neurotrophic factor (BDNF), promoting neuronal survival, synaptic plasticity, and neurogenesis. The optimal protocols identified involved 2-3 sessions per week for 4-12 weeks, using specific points such as ST-36 (Zusanli), LI-4 (Hegu), and SP-6 (Sanyinjiao). Electroacupuncture showed superior efficacy compared with traditional acupuncture.

The results showed that acupuncture was particularly effective for CIPN induced by taxanes (such as paclitaxel) and platinum-based agents (such as oxaliplatin), offering both preventive benefits when applied during chemotherapy and therapeutic benefits for established symptoms. The intervention demonstrated a better safety profile compared with conventional medications, with lower incidence of adverse effects and greater patient satisfaction. The studies showed consistent improvements in neuropathic pain, sensory function, and overall quality of life. Identified limitations include heterogeneity of acupuncture protocols across studies, small sample sizes in some trials, and methodologic difficulties inherent in blinding for acupuncture studies.

The authors emphasize the need for standardization of protocols and conducting larger and higher-quality clinical trials. Clinical implications suggest that acupuncture can be integrated as adjunctive therapy in the multimodal management of CIPN, potentially reducing dependence on medications with significant side effects. Current evidence positions acupuncture as a promising therapeutic option, especially considering its safety and well-grounded neurobiologic mechanisms.