Evidence-based recommendations for CIP neuropathy
Updated: Dec 23, 2020
Today I'm bringing you a condensed look at a very interesting systematic review about chemotherapy induced peripheral neuropathy, and evidence-based treatments for this particular disorder.
What is chemotherapy-induced peripheral neuropathy?
Let me do a quick recap for you on chemotherapy induced peripheral neuropathy. It is a sensory peripheral neuropathy. Although it can at times include motor neuropathy or autonomic neuropathy, the sensory neuropathy is one that is most commonly diagnosed. It's most noticeable for patients as well. Typically in a stocking and glove distribution, so you'll have patients that have it in the hands and the feet.
The common complaints are a straight up pain. There can be loss of sensation, numbness, paresthesia, tingling, oftentimes gait disturbance is included. Although many patients don't notice that one as much, loss of balance is involved as well. And one of the things with chemotherapy induced peripheral neuropathy is that it can actually affect overall survival for cancer patients, because if it becomes severe enough, then many times oncologists are forced to dial back the intensity of the treatment regimen, which, sometimes even can lead to discontinuation of the treatment. And obviously that's going to affect the outcomes for these cancer patients.
Anywhere from 60 to 80% of patients who have chemotherapy will develop neuropathy symptoms. About 50% of the people who develop peripheral neuropathy will have good reduction of the symptoms about three months after the onset. But there are many people, in some cases up to 80% of patients, that even six months or two years after cessation of chemotherapy can have ongoing symptoms.
CIPN vs Diabetic Neuropathy
Now, chemotherapy induced peripheral neuropathy is different than diabetic peripheral neuropathy. Diabetes causes specific changes in ion channel expressions and peripheral nerve fibers, which in turn leads to hyper-excitability. So, the dysregulation of voltage gated calcium channels is what really leads to enhance calcium influx in those sensory neurons. And then the hyperexcitability leads to neuropathic pain.
In chemotherapy induced peripheral neuropathy, we're talking about axonal degeneration as the most common process, including defects in axon transport, altered mitochondrial function, and altered calcium ion homeostasis. Even depending on the chemotherapy drug that is used, you can have different mechanisms of injury to the nerves.
Out of the 26 treatments included in the study, only two made the cut as being evidence based recommendable practices for chemotherapy induced peripheral neuropathy.
So, to quote from the study, there is moderate benefit for duloxetine or Cymbalta, and also moderate benefit for photo biomodulation known as low level laser therapy. That was it. Out of 26 treatments, laser therapy and Cymbalta were the only ones that made the cut. Currently the ACSO only promotes use of Cymbalta as a moderately beneficial, but still limited for chemotherapy induced peripheral neuropathy. This study is saying, yes, Cymbalta can be used. It has evidence behind it. The only other treatment with evidence that is sufficient to recommend its use is low level laser therapy.
Now, like I said, 26 different treatments that were examined only two made the cut. So, what did not make the cut? What are the 24 treatments that are not supported by evidence? Check out the podcast to hear the full list.
Laser Therapy for Chemotherapy-induced Peripheral Neuropathy
So, what do you do with this information? Well, number one, if you're involved in caring for cancer patients, the numbers and the data, the evidence says you should be using laser to not only help your patients pain levels with neuropathy, but also to keep them on their chemotherapy regimen. Obviously, that is the goal here to get the patient through the treatment that they need for their cancer care. And you can't do that if they can can't tolerate the treatment, if the symptoms of neuropathy are so bad. And like we said before, the numbers say 60 to 80% of patients are going to experience neuropathy associated with using the use of chemotherapy drugs that obviously they need. So, you should be using laser to assist these patients. There are no medication interactions. There are no known side effects of laser therapy. There is no reason not to be using laser when it is an evidence-based treatment for this particular disorder. You'll enable patients to stay on the treatment regimen that they need.
If you already are laser therapy provider, then this information right here is critical to get to your local oncologists and neurologists so that they know that you can provide an evidence based treatment that will help their patients maintain their chemotherapy regimen, that will help their patients be more comfortable, and that will not complicate the medication schedules that the patient is already on. This is a well-tolerated process. It's a natural method of keeping these symptoms under control. And especially for those patients that are already six months or a year or two years past when they had chemotherapy and are still suffering with the symptoms of peripheral neuropathy, what do you do? You don't want patients on medications for years when you have potentially a way to reduce those symptoms through laser therapy.
Laser Therapy Neuropathy Training
If you have questions as a provider on how to do integrate laser into your cancer center or into your neurology practice, please get ahold of me. We have the protocols, we have the guidelines to help you get this going right away and start getting your patient's benefits tomorrow. You can make this happen very easily by going through Laser Therapy Institute's program of training certification and using our custom protocols. Laser Therapy Institute now has basic training in addition to a special neuropathy package, you can get just that information specifically to get you on the fast track to having solutions for your patients, ready to go tomorrow and helping those patients start feeling better right now.
If you're already providing laser and you need help getting this information to the healthcare practitioners in your area, to get them to refer patients to you, we can help you with that as well. And we can make sure that you are using protocols that work. We can take the guesswork right out of this for you. Thanks for joining me this week. I look forward to seeing you next week. Send me an email. If you need help firstname.lastname@example.org.