Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.
Wuxi Hospital of Traditional Chinese Medicine, Wuxi, China.
Acupunct Med. 2023 Apr;41(2):73-85. doi: 10.1177/09645284221076512. Epub 2022 Jun 12.
Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting adverse effect of anticancer agents with virtually no effective treatment. Safe and effective therapies are needed urgently. Acupuncture shows therapeutic possibilities in this regard but needs to be further evaluated.
A systematic search was conducted in seven databases from their inception to April 2020. Randomized controlled trials (RCTs) focused on acupuncture/electroacupuncture (EA) for the treatment of CIPN were included. Revman 5.3 software was used for meta-analysis if there was no significant heterogeneity. Otherwise, qualitative analysis was utilized.
Nine studies involving 582 patients were included in this review. Most of the studies exhibited unclear risk of bias because some details were not mentioned. As the clinical heterogeneity was significant, qualitative analysis was performed to describe nerve conduction velocity, effective rate for motor neuropathy, pain scores, quality of life and adverse events. Meta-analysis was performed on four studies to analyze the effective rate for sensory neuropathy due to inconspicuous heterogeneity. The results indicated that acupuncture may generate a better effect on sensory neuropathy than vitamin B (risk ratio = 1.60, 95% confidence interval = 1.31-1.95, I = 0%, p < 0.00001). The efficacy of EA plus glutathione (GSH) appeared to be better than that of GSH alone in alleviating sensory neurotoxicity and in improving nerve conduction velocity. Acupuncture plus methylcobalamin showed more favorable effects than methylcobalamin alone in relieving neuralgia, restoring nerve conduction velocity and improving quality of life. In terms of pain relief and improved CIPN-specific quality of life, acupuncture plus standard care was better than standard care alone. In terms of pain relief, EA was more effective than usual care.
Acupuncture may be effective and safe in the treatment of CIPN according to the analyzed studies. However, more studies with higher methodological quality are warranted in order to be able to draw firmer conclusions. Future rigorous RCTs will be necessary to confirm the effectiveness and safety of acupuncture for CIPN.
化疗引起的周围神经病（CIPN）是一种具有几乎无效治疗方法的抗癌药物的剂量限制不良作用。急需安全有效的治疗方法。针灸在这方面显示出了治疗的可能性，但需要进一步评估。
从七个数据库的创建开始到 2020 年 4 月进行了系统搜索。纳入了专注于针灸/电针（EA）治疗 CIPN 的随机对照试验（RCT）。如果没有显著异质性，则使用 Revman 5.3 软件进行荟萃分析。否则，将进行定性分析。
本综述共纳入了 9 项研究，涉及 582 名患者。由于未提及一些细节，大多数研究的偏倚风险不明确。由于临床异质性显著，因此进行了定性分析以描述神经传导速度、运动神经病的有效率、疼痛评分、生活质量和不良事件。由于异质性不明显，对四项研究进行了荟萃分析以分析感觉神经病的有效率。结果表明，针灸在治疗感觉神经病方面可能比维生素 B 更有效（风险比=1.60，95%置信区间=1.31-1.95，I=0%，p<0.00001）。与单独使用谷胱甘肽（GSH）相比，EA 加 GSH 似乎在缓解感觉神经毒性和改善神经传导速度方面更有效。与单独使用甲钴胺相比，针灸加甲钴胺在缓解神经痛、恢复神经传导速度和改善生活质量方面更有效。在缓解疼痛和改善 CIPN 特异性生活质量方面，针灸加标准护理优于单独使用标准护理。在缓解疼痛方面，EA 比常规护理更有效。
根据分析研究，针灸治疗 CIPN 可能是有效且安全的。但是，为了能够得出更确定的结论，需要更多具有更高方法学质量的研究。未来需要进行严格的 RCT 以确认针灸治疗 CIPN 的有效性和安全性。
