Garcia, M.K., Cohen, L., Guo, Y., Zhou, Y., You, B., Chiang, J., . . . Wang, M. (2014). Electroacupuncture for thalidomide/bortezomib-induced peripheral neuropathy in multiple myeloma: A feasibility study. Journal of Hematology and Oncology, 7, 41-8722-7-41.
To evaluate the safety and initial efficacy of acupuncture for the treatment of thalidomide and bortezomib-induced chronic peripheral neuropathy (PN)
Standardized acupuncture medication and equipment was used by two licensed acupuncturists three times per week for four weeks (one week of rest; two times per week for four weeks). Both upper extremities and both lower extremities had the same point sites of treatment. After participants experienced a sensation of numbness, tingling, or warmth at the needle insertion site, an electrical stimulation was applied bilaterally for 20 minutes after completion of 80% of treatment sessions.
Nonrandomized, pilot feasibility, safety and efficacy study with a quasi-experimental design
The National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE) were used to evaluate for PN prior to beginning the study. The General Functional Assessment of Cancer Therapy (FACT-G) and the Brief Pain Inventory Short Form (BPI-SF) were used to evaluate patient-reported outcomes and baseline and at weeks 4, 9, and 13 during the study. Objective measurements (coin test, button test, walking test, postural stability/fall risk) and bilateral tibial and sural sensory nerve conduction tests were conducted at baseline and at week 13. The FACT and Gynecologic Oncology Group-Neurotoxicity (GOG-NTX) scales were used to assess the primary thee endpoints for PN at baseline and at weeks 4, 9, and 13. Evaluable patients completed 80% of the study medication.
BPI-SF scores significantly improved in regard to pain severity with the worst pain occurring at 24 hours at all time points with large effect sizes in weeks 9 and 13. There was a significant improvement in BPI-SF pain interference in weeks 9 and 13 with a moderate effect size. FACT and GOG-NTX scores showed significant improvement in weeks 4, 9, and 13. Timed motor function tests from baseline to one month after the beginning of the study showed significant improvement. There was no statistically significant difference for fall risk, and nerve conduction studies demonstrated no change.
This feasibility, safety, and efficacy trial of electroacupuncture in 19 patients experiencing bortezomib- or thalidomide-induced PN demonstrated significant improvements in patient-reported outcomes for pain severity and interference according to the BPI-SF, FACT and GOG-NTX scores, and objective timed motor function tests from baseline to 13 weeks. No safety issues were reported.
The use of electroacupuncture requires additional study in large, randomized, controlled trials to establish safety, benefits, the duration and sustainability of benefits, and treatment recommendations as an adjunct therapy for bortezomib- and thalidomide-induced PN.