Thank you all for this wonderful and rich discussion. CIPN is truly an
adverse effect of cancer treatment that is very challenging to treat. Thank
you all for the great evidence regarding exercise, manual therapy, and
modalities. I agree that the placebo effect is powerful. I also agree that
more research is definitely needed. We also use capsaicin cream with good
results.
My hope is that we can also find more ways to prevent CIPN from
ever happening. We recommend cold treatment to hands and feet 10 minutes
out of every hour of infusion, along with massage. Of course that will not
treat the vestibulocochlear, phrenic, rectal nerves, and other nerves that
are affected but does help for the hands and feet. And yes, this
intervention needs more research as well.
What brings me great joy is that there are so many of you out there using
your expertise and creativity to develop more treatment interventions for
CIPN to improve the quality of life of each and every person diagnosed with
cancer.
You are all so wonderful!! and such a blessing to our profession!
Deb
On Sun, Dec 5, 2021 at 6:50 AM EARLLAINE CROARKIN <
dmarc-noreply@xxxxxxxxxxxxx> wrote:
I'm going to tag onto Meredith's email, which was awesome. Thank you
Meredith. -for those searching for treatment ideas based in RCTs. -for
those who might not have access to the e-stim machines mentioned earlier in
the thread or want an option for family members / care providers.
Massage
Izgu, N., Metin, Z. G., Karadas, C., Ozdemir, L., Çetin, N., & Demirci, U.
(2019). Prevention of chemotherapy-induced peripheral neuropathy with
classical massage in breast cancer patients receiving paclitaxel: An
assessor-blinded randomized controlled trial. *European Journal of
Oncology Nursing*, *40*, 36-43.
Authors documented method of massage.
Menendez, A. G., Cobb, R., Carvajal, A. R., Healey, K., D'Ambra, D., &
Espat, N. J. (2016). Effectiveness of massage therapy (MT) as a treatment
strategy and preventive modality for chemotherapy-induced peripheral
neuropathy (CIPN) symptoms.
Cunningham, J. E., Kelechi, T., Sterba, K., Barthelemy, N., Falkowski, P.,
& Chin, S. H. (2011). Case report of a patient with chemotherapy-induced
peripheral neuropathy treated with manual therapy (massage). *Supportive
Care in Cancer*, *19*(9), 1473-1476.
Foot Baths
Park, Ranhee PhD, RN; Park, Chaisoon PhD Comparison of Foot Bathing and
Foot Massage in Chemotherapy-Induced Peripheral Neuropathy, Cancer Nursing:
May/June 2015 - Volume 38 - Issue 3 - p 239-247
doi: 10.1097/NCC.0000000000000181
(This is a case series out of Korea they did, however, use a device to
keep the temperature of the bath consistent.)
Regards,
Earllaine Croarkin, PT, MPT
Board Certified Neurological Specialist
Clinical Research Center, NIH
On Saturday, December 4, 2021, 10:56:28 AM EST, Meredith Wampler-Kuhn <
dmarc-noreply@xxxxxxxxxxxxx> wrote:
I would echo Heidi's comments. We cannot feel confident in the efficacy of
these modalities unless there are good RCTs but to not undersell the power
of placebo effect while waiting. And if you have other modalities that you
can get reimbursed for and that are not an out-of-pocket expense to your
patient is that a better choice?
I would throw it out there that another treatment modality that we do
provide that may provide efficacy for CIPN symptoms is aerobic exercise
(which has a lot of other positive effects on general health, cancer
related fatigue, etc.). Walking is not the best modality for these folks if
they have painful neuropathy or balance problems. But seated bike or
recumbent ellipticals like the NuStep are great options. I will often do
this in conjunction with manual therapy and trigger point release and
getting them into orthotics with nice improvements to functional outcomes
like the 6-minute walk test and some subjective reports of improvement in
symptoms.
Here are a few articles (there are more but these could get you started).
I included a few from the diabetic literature because they have more trials
than the CIPN population but may offer some insight as well.
--Meredith
1. PMID: 29198853
Effects of exercise on cancer patients suffering chemotherapy-induced
peripheral neuropathy undergoing treatment: A systematic review.
<https://pubmed.ncbi.nlm.nih.gov/29198853/>
Duregon F, Vendramin B, Bullo V, Gobbo S, Cugusi L, Di Blasio A,
Neunhaeuserer D, Zaccaria M, Bergamin M, Ermolao A.Crit Rev Oncol
Hematol. 2018 Jan;121:90-100. doi: 10.1016/j.critrevonc.2017.11.002. Epub
2017 Nov 7.PMID: 29198853 Review.
2. PMID: 30462877Aerobic exercise training may improve nerve function in
type 2 diabetes and pre-diabetes: A systematic review.
<https://pubmed.ncbi.nlm.nih.gov/30462877/>Gu Y, Dennis SM, Kiernan MC,
Harmer AR.
Diabetes Metab Res Rev. 2019 Feb;35(2):e3099. doi: 10.1002/dmrr.3099. Epub
2018 Dec 7. PMID: 30462877
3. PMID: 30756229Exercise-based rehabilitation for cancer survivors with
chemotherapy-induced peripheral neuropathy.
<https://pubmed.ncbi.nlm.nih.gov/30756229/>McCrary JM, Goldstein D,
Sandler CX, Barry BK, Marthick M, Timmins HC, Li T, Horvath L, Grimison P,
Park SB.
Support Care Cancer. 2019 Oct;27(10):3849-3857. doi:
10.1007/s00520-019-04680-w. Epub 2019 Feb 12. PMID: 30756229
4. PMID: 31626055Exercise Guidelines for Cancer Survivors: Consensus
Statement from International Multidisciplinary Roundtable.
<https://pubmed.ncbi.nlm.nih.gov/31626055/>Campbell KL, Winters-Stone KM,
Wiskemann J, May AM, Schwartz AL, Courneya KS, Zucker DS, Matthews CE,
Ligibel JA, Gerber LH, Morris GS, Patel AV, Hue TF, Perna FM, Schmitz KH.
Med Sci Sports Exerc. 2019 Nov;51(11):2375-2390. doi:
10.1249/MSS.0000000000002116. PMID: 31626055 Free PMC article.
Meredith Wampler-Kuhn, PT, DPTSc
Board Certified Oncologic Physical Therapist
541-706-6335
makuhn@xxxxxxxxxxxxxxxxxxxxxxx
St. Charles Cancer Center
2600 Neff Road
Bend, OR 97701
------------------------------
*From:* aptaoncology-bounce@xxxxxxxxxxxxx <
aptaoncology-bounce@xxxxxxxxxxxxx> on behalf of heidi engel <
dmarc-noreply@xxxxxxxxxxxxx>
*Sent:* Friday, December 3, 2021 5:25 PM
*To:* aptaoncology@xxxxxxxxxxxxx <aptaoncology@xxxxxxxxxxxxx>
*Subject:* [aptaoncology] Re: CIPN treatment -is The Rebuilder electrical
stimulator a viable option from Alane acurry
*EXTERNAL EMAIL* - If suspicious, do not click on links or open
attachments and use Phish Alert to report.
Thanks for asking- when there’s a RCT with the device versus a shame
device, we will have a better answer. The vast majority of devices for pain
and sensory issues and manual therapies are placebo effects. There is
Nothing wrong with that at all. The body heals itself more than we give it
credit for in Medicine (I’m not talking about chemotherapy right?).
Placebos are healing, not a system of tricking the patient. Placebos are
legitimate- read some of the sham back surgery studies for example. Thus,
the good news is that we may be able to achieve a similar result for no
money..,
that’s my only point here.
-Heidi
Sent from my iPhone
On Dec 3, 2021, at 2:33 PM, alane curry <dmarc-noreply@xxxxxxxxxxxxx>
wrote:
Deb: the question in the thread is:
-Is the Rebuilder an effective treatment for CIPN?
-Potential Journal articles that may support this modality as a viable
treatment.
Thanks so much,
Alane Curry
Sent from my iPhone
On Dec 3, 2021, at 2:33 PM, Deborah Doherty <doherty@xxxxxxxxxxx> wrote:
Heidi
I'm confused. In the email string about the Rebuilder, Perry Ashley
stated: B*asically the device is utilized to help refill blood
capillaries and help regain sensation through the legs and feet. *However,
you are stating it is a placebo effect. Does this device provide a true
physiological effect or a placebo effect. Or maybe I missed some of the
conversation.Thank you for helping me understand this.
Deb
On Fri, Dec 3, 2021 at 10:21 AM heidi engel <dmarc-noreply@xxxxxxxxxxxxx>
wrote:
And the greater the patient compliance and attention to the protocol use
of the device, the stronger the placebo effect. Chances are the same sort
of neuropathic distractive effect with placebo could be delivered in a
variety of ways at less expense. Be creative or design a RCT with a placebo
device!
-Heidi Engel, PT, DPT
Sent from my iPhone
On Dec 3, 2021, at 6:37 AM, Perry Ashley <dmarc-noreply@xxxxxxxxxxxxx>wrote:
--
Deb Doherty, PT, PhD
she/her/hers
Associate Professor
Chair of Human Movement Science Department
Chair Interprofessional Education Task Force
Coordinator of the Graduate Certificate in Oncology Rehabilitation
Oakland University
Physical Therapy Program
3176 Human Health Building Room
433 Meadowbrook Road
Rochester, Michigan 48309
Phone: (248) 364-8683; FAX: (248) 364-8660
E-mail: doherty@xxxxxxxxxxx
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