Neuropatisk Smärta


Trials 2018: 19:526

The evaluation of changes in peripheral neuropathy and quality-of-life using lowfrequency 

electrostimulation in patients treated with chemotherapy for breast 


Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a progressive, enduring, and sometimes

irreversible neurotoxic symptom that occurs in 30–40% of chemotherapy-treated cancer patients. CIPN negatively

affects both the patient’s abilities to perform daily activities and their health-related quality of life (HRQOL) after

chemotherapy treatment. Although this neuropathy has been treated with duloxetine and/or gabapentin, limited

therapeutic benefits have been reported, thereby necessitating the development of an integrated approach that

combines pharmacological management and complementary methods such as acupuncture and electric nerve

stimulation. Therefore, this study is designed to examine the effect of a portable, low-frequency lectrostimulation (ES)device on CIPN symptoms and HRQOL of female patients diagnosed with CIPN immediately after hemotherapy for breast cancer.

Methods: This study is a single-center, randomized, placebo-controlled trial with two parallel groups and a 2-week follow-up. We will enroll 80 breast cancer patients who are newly diagnosed with CIPN after chemotherapy. Duloxetine or pregabalin will be prescribed to all participants from the initial assessment. Half of the patients will be assigned into the experimental group and the other half to the control group. The CarebandR (Piomed Inc., Seoul, Korea), a wearable wristband that generates low-frequency electrostimulation, will be administered only to the experimental group. Electrostimulation will be administered on the unilateral PC6 acupoint. A  numerical rating scale will be used to assess the overall intensity of CIPN symptoms. The key secondary outcome variables include patient-reported CIPN symptom distress tested by a self-rated questionnaire, physician-rated symptom

severity assessed by the Total Neuropathy Score, and HRQOL.

Discussion: It is expected that the combination of a low-frequency electrostimulation device and pharmacological intervention (duloxetine or pregabalin) will produce synergistic effects in breast cancer patients with Chemotherapy-induced peripheral neuropathy (CIPN) after treatment.

To our knowledge, this is the first study to investigate the beneficial effect of a new integrated approach for CIPN

management after breast cancer treatment. The study findings can expand our knowledge and understanding of the occurrence of CIPN and the efficacy of integrated intervention efforts to ameliorate CIPN symptoms.

Trial registration: Clinical Research Information Service (CRIS), Republic of Korea, ID: KCT0002357. Registered

retrospectively on 13 June 2017.

Chang eun Jang et al.


Acupunct Med 2011;29:108–115.

Acupuncture and massage therapy for neuropathic pain following spinal cord injury: an exploratory study

Objective The study sought to explore the possibility of using acupuncture and massage therapy for relieving neuropathic pain following spinal cord injury (SCI). Design 30 individuals with SCI and neuropathic pain were assigned to treatment of either massage or acupuncture, with 15 individuals in each group. Both groups received treatment twice weekly for 6 weeks. Treatments were evaluated at the end of treatment and 2 months later (follow-up).

Results Data were analysed on an intention- totreat basis. Within the groups, ratings of present pain, general pain, pain unpleasantness and coping

improved signifi cantly at the end of treatment after acupuncture compared to baseline values, and following massage therapy ratings of pain interference

on the Multidimensional Pain Inventory improved. At follow-up no signifi cant improvements were seen.

Between-group differences were seen regarding ratings of worst pain intensity at the end of treatment, and regarding pain unpleasantness and coping with pain at follow-up, both in favour of

acupuncture. At the end of treatment, eight of the 15 individuals receiving acupuncture and nine receiving massage reported an improvement on the Patient Global Impression of Change Scale, and at follow-up six patients in the acupuncture group and one patient in the massage group still reported a

favourable effect from the treatment.

Few side effects were reported and neither dropout from the study did this due to adverse events.

Conclusion Neuropathic pain following SCI is often only partially responsive to most interventions. Results from this study indicate, however, that both

acupuncture and massage therapy may relieve SC neuropathic pain. For this reason, larger randomised controlled trials are warranted for assessing the

long-term effects of these treatments.

Cecilia Norrbrink &

Thomas Lundeberg

Kvinna som får akupunktur

Korean J Physiol Pharmacol 2017;21(6):657-666

The efficacy of combination treatment of gabapentin and

electro-acupuncture on paclitaxel-induced neuropathic pain

ABSTRACT Paclitaxel, a chemotherapeutic drug, induces severe peripheral neuropathy.

Gabapentin (GBT) is a first line agent used to treat neuropathic pain, and its effect is mediated by spinal noradrenergic and muscarinic cholinergic receptors. Electro-

acupuncture (EA) is used for treating various types of pain via its action through spinal opioidergic and noradrenergic receptors. Here, we investigated whether combined

treatment of these two agents could exert a synergistic effect on paclitaxelinduced cold and mechanical allodynia, which were assessed by the acetone drop test and von Frey filament assay, respectively. Significant signs of allodynia were observed after four paclitaxel injections (a cumulative dose of 8 mg/kg, i.p.). GBT (3, 30, and 100 mg/kg, i.p.) or EA (ST36, Zusanli) alone produced dose-dependent anti-allodynic

effects. The medium and highest doses of GBT (30 and 100 mg/kg) provided

a strong analgesic effect, but they induced motor dysfunction in Rota-rod tests. On the contrary, the lowest dose of GBT (3 mg/kg) did not induce motor weakness, but it provided a brief analgesic effect. The combination of the lowest dose of GBT and EA resulted in a greater and longer effect, without inducing motor dysfunction. This effect

on mechanical allodynia was blocked by spinal opioidergic (naloxone, 20 mg), or

noradrenergic (idazoxan, 10 mg) receptor antagonist, whereas on cold allodynia, only opioidergic receptor antagonist blocked the effect. In conclusion, the combination

of the lowest dose of GBT and EA has a robust and enduring analgesic action against paclitaxel-induced neuropathic pain, and it should be considered as an alternative ​treatment method.

Min Joon Kim et al.