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:
Basically 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<mailto: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<mailto:dmarc-noreply@xxxxxxxxxxxxx>> wrote:
