Non-pharmacological therapy for chemotherapy-induced peripheral neurotoxicity: a network meta-analysis of randomized controlled trials.
Study Goal
The researchers aimed to identify the most effective non-pharmacological therapy for chemotherapy-induced peripheral neurotoxicity (CIPN), with a focus on comparing massage to other interventions.
Results Summary
The study found that massage was more effective than other non-pharmacological therapies (e.g., acupuncture, vitamin and gabapentin, usual care, and placebo) in alleviating pain, improving quality of life, and reducing peripheral neuropathological symptoms. It also outperformed sensorimotor training, electrostimulation, multimodal exercise, and resistance training in attenuating neuropathological symptoms.
Population
Patients undergoing chemotherapy who experienced chemotherapy-induced peripheral neurotoxicity (CIPN).
Effective Dosage
Not available
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
massage | decrease | pain | CIPN patients | SMD = 0.81, 95%CI (0.04, 1.57) | was more effective in pain-alleviating compared with acupuncture | #1 |
massage | decrease | pain | CIPN patients | SMD = 2.56, 95%CI (1.39, 3.74) | was more effective in pain-alleviating compared with vitamin and gabapentin | #2 |
massage | decrease | pain | CIPN patients | SMD = 0.9, 95%CI (0.31, 1.49) | was more effective in pain-alleviating compared with usual care and placebo | #3 |
massage | decrease | peripheral neuropathological symptoms | CIPN patients | SMD = 0.75, 95%CI (0.33, 1.17) | was more effective than usual care and placebo for attenuating peripheral neuropathological symptoms | #4 |
massage | decrease | peripheral neuropathological symptoms | CIPN patients | SMD = 1.17, 95%CI (0.24, 2.10) | was more effective than sensorimotor training for attenuating peripheral neuropathological symptoms | #5 |
massage | decrease | peripheral neuropathological symptoms | CIPN patients | SMD=-1.18, 95%CI (-2.14, -0.21) | was more effective than electrostimulation for attenuating peripheral neuropathological symptoms | #6 |
massage | decrease | peripheral neuropathological symptoms | CIPN patients | SMD=-0.82, 95%CI (-1.57, -0.08) | was more effective than multimodal exercise for attenuating peripheral neuropathological symptoms | #7 |
massage | decrease | peripheral neuropathological symptoms | CIPN patients | SMD = 1.03, 95%CI (0.11, 1.95) | was more effective than resistance training for attenuating peripheral neuropathological symptoms | #8 |
massage | increase | quality of life | CIPN patients | - | was more effective than other non-pharmacological therapies in improving quality of life | #9 |
massage | increase | sensory symptoms | CIPN patients | - | was more effective than other non-pharmacological therapies in improving sensory symptoms | #10 |
massage | increase | motor symptoms | CIPN patients | - | was more effective than other non-pharmacological therapies in improving motor symptoms | #11 |
BACKGROUND: Chemotherapy-induced peripheral neurotoxicity (CIPN) is the most common adverse effect in patients undergoing chemotherapy, and no effective interventions are currently available for its prevention and treatment. Non-pharmacological therapies appear to be beneficial for the prevention and treatment of CIPN, but it remains unclear which therapy is most effective. The aim of this study was to identify the most effective non-pharmacological therapy for CIPN patients. METHODS: PubMed, Web of Science, Embase, and Cochrane Library were searched for randomized controlled trials on non-pharmacological therapies for CIPN. The primary outcomes included pain and peripheral neuropathological symptoms, and the secondary outcomes included quality of life, sensory and motor symptoms. The pairwise analysis and a network meta-analysis were performed using a random effects model. RESULTS: A total of 46 articles were included in this study, involving 2,878 participants. Our study showed that massage was more effective in pain-alleviating compared with acupuncture [SMD = 0.81, 95%CI (0.04, 1.57)], vitamin and gabapentin [SMD = 2.56, 95%CI (1.39, 3.74)], and usual care and placebo [SMD = 0.9, 95%CI (0.31, 1.49)]. As for attenuating peripheral neuropathological symptoms, massage was more effective than usual care and placebo [SMD = 0.75, 95%CI (0.33, 1.17)], sensorimotor training [SMD = 1.17, 95%CI (0.24, 2.10)], electrostimulation [SMD=-1.18, 95%CI (-2.14, -0.21)], multimodal exercise [SMD=-0.82, 95%CI (-1.57, -0.08)], and resistance training [SMD = 1.03, 95%CI (0.11, 1.95)]. Massage was also more effective than other non-pharmacological therapies in improving quality of life, sensory and motor symptoms. CONCLUSIONS: According to our study, massage has advantages in alleviating pain, improving quality of life, and improving peripheral neuropathological symptoms and has better effect than other non-pharmacological interventions, representing certain clinical significance. However, the results of this study should be interpreted with caution due to the limitations of the included studies. In the future, more high-quality multi arm randomized controlled trials can be attempted to provide direct comparisons of the relative effects of non-pharmacological interventions.