Physical therapy, exercise and acupuncture for the prevention and treatment of chemotherapy induced peripheral neuropathy

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Hammond, Elizabeth R Andersen
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Chemotherapy induced peripheral neuropathy (CIPN) can have lasting sensory effects for cancer survivors. At present, the mechanisms causing the neuropathy are unknown and few effective treatment options are available. This thesis includes a review of the literature and four studies. The first study evaluated the potential role for physical therapy and nerve gliding home exercises to improve symptoms of CIPN and explored whether a dual nerve disorder was present between the surgical and non-surgical side in a population with breast cancer. The nerve gliding exercises had a positive effect on pain as measured by the numeric pain rating scale (NPRS) and pain pressure algometry. No quantitative sensory testing (QST) data could identify a possible dual nerve disorder from surgery combined with chemotherapy. The second trial sought to confirm the effectiveness of electro acupuncture on improving chronic neuropathic pain from CIPN. This trial showed the ineffectiveness of electro acupuncture for chronic CIPN pain symptoms. The third study used the physical therapy study data to define the sensory phenotypes of neuropathic and non-neuropathic symptom profiles. This was completed to identify future targets for mechanism-based treatment. Surprisingly, only left hand heat pain threshold differences were observed on the QST measures. As expected, increased pain (measured by the NPRS) and decreased function (measured by the Disability of the Shoulder, Arm and Hand (DASH)) were observed in the neuropathic group. Using the physical therapy data, the fourth study correlated active participants with preservation of nerve function exploring the possible neuroprotective effect of exercise on CIPN. ‘Active’ versus ‘less active’ groups revealed significantly improved vibration perception and normalized heat pain thresholds for the active group suggesting possible neuroprotection among exercisers. This thesis helps to direct evidence-based practice and contributes to the literature. Our findings indicate that electro acupuncture should not be pursued as a treatment option for patients experiencing chronic pain from CIPN. Our findings support the use of physical therapy, nerve gliding exercises, and general exercise during and after chemotherapy. Physical therapy and nerve gliding exercises help reduce the symptoms associated with chemotherapy induced peripheral neuropathy while maintaining physical activity throughout treatment may provide neuroprotection.
Chemotherapy induced peripheral neuropathy, Physical therapy, Nerve gliding exercises, Neuropathic pain, Breast cancer, Exercise, Small fibre neuropathy, Acupuncture, Electro acupuncture