Patient with needles

Acupuncture alleviates neuropathic symptoms due to chemotherapy-induced peripheral neuropathy (CIPN) in breast cancer survivors. A randomized-controlled trial was conducted at the Dana-Farber Cancer Institute (Boston, Massachusetts). The results demonstrate that an 8-week intensive acupuncture protocol (18 sessions) greatly reduces pain intensity levels, pain interference, and average pain levels. [1] The results also show significant improvements in CIPN-specific and general quality of life scores, functional assessment of cancer therapy neurotoxicity subscales, and brief pain inventory short-form scores. In addition, stage I–III breast cancer patients with persistent CIPN after chemotherapy had better neurotoxicity questionnaire sensory scores (PNQ) over waitlist control patients. Moreover, low intensity acupuncture treatment regimens contributed to clinically significant reductions in sensory CIPN symptoms.

For the first week, researchers inserted acupuncture needles (0.20 × 25 mm and 0.25 × 40 mm) into specified main points to obtain the deqi sensation. From the second week to the eighth week, electroacupuncture was applied to TB5 (Waiguan) and Baxie (second) or SP6 (Sanyinjiao) and LR3 (Taichong), bilaterally. Acupoints were applied according to locations of CIPN symptoms, using alternating 2–10 Hz for 30 minutes each session. If the patients were very comfortable with acupuncture, researchers added Ex-LE12 (Qiduan) as a treatment point. Secondary treatment points included Ex-LE10 (Bafeng), LI11(Quchi), ST36 (Zusanli), SP9 (Yinlingquan), K3 (Taixi), and Yintang.

Chemotherapy drugs like Taxanes and platinum agents (especially paclitaxel and docetaxel) are widely used in the early stage and metastatic stages of breast cancer treatment, which can cause CIPN. The symptoms of CIPN vary, but usually present with pain and paresthesia. The incidence of CIPN in patients with breast cancer ranges between 30% and 97%, which is related with poor physical function, increased risk of falling, and greater disability in cancer survivors.

Many studies focus on medications or dietary supplements to treat CIPN in patients with cancer, including pharmacologic agents like duloxetine, antidepressants, anticonvulsants, non-narcotic and narcotic analgesics, or dietary supplements like glutamine, glutathione, vitamin E, and vitamin B12. Many treatments cause different types of side effects such as fatigue, dizziness, insomnia, and nausea.

Acupuncture is proven to be safe and demonstrates efficacy in alleviation of CIPN symptoms, improving nerve system conduction, and reducing symptom distress. [2–5] Importantly, acupuncture effectively prevents deterioration of CIPN from grade II to grade III in breast cancer patients after finishing paclitaxel chemotherapy. [7]

References:
[1]Weidong Lu, Anita Giobbie‐Hurder, Rachel A. Freedman, Im Hee Shin, Nancy U. Lin, Ann H. Partridge, David S. Rosenthal, and Jennifer A. Ligibel. Acupuncture for Chemotherapy–Induced Peripheral Neuropathy in Breast Cancer Survivors: A Randomized Controlled Pilot Trial. The Oncologist 2020;25:310–318.
[2]11. Bao T, Seidman AD, Piulson L et al. A phase IIa trial of acupuncture to reduce chemotherapy-induced peripheral neuropathy severity during neoadjuvant or adjuvant weekly paclitaxel chemotherapy in breast cancer patients. Eur J Cancer 2018;101:12–19.
[3] Garcia MK, Cohen L, Guo Y et al. Electroacupuncture for thalidomide/bortezomib-induced peripheral neuropathy in multiple myeloma: A feasibility study. J Hematol Oncol 2014;7:41.
[4] Molassiotis A, Suen LKP, Cheng HL et al. A randomized assessor-blinded wait-list-controlled trial to assess the effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy. Integr Cancer Ther 2019; 18:1534735419836501.
[5] Han X, Wang L, Shi H et al. Acupuncture combined with methylcobalamin for the treatment
of chemotherapy-induced peripheral neuropathy in patients with multiple myeloma. BMC Cancer 2017;17:40.
[6]Xu WR, Hua BJ, Hou W et al. Clinical randomized controlled study on acupuncture for treatment of peripheral neuropathy induced by chemotherapeutic drugs [in Chinese]. Zhong guo Zhen Jiu 2010;30:457–460.
[7]11. Bao T, Seidman AD, Piulson L et al. A phase IIa trial of acupuncture to reduce chemotherapy-induced peripheral neuropathy severity during neoadjuvant or adjuvant weekly paclitaxel chemotherapy in breast cancer patients. Eur J Cancer 2018;101:12–19.

This gentle form of exercise can help maintain strength, flexibility, and balance, and could be the perfect activity for the rest of your life.

Tai chi is often described as “meditation in motion,” but it might well be called “medication in motion.” There is growing evidence that this mind-body practice, which originated in China as a martial art, has value in treating or preventing many health problems. And you can get started even if you aren’t in top shape or the best of health.

In this low-impact, slow-motion exercise, you go without pausing through a series of motions named for animal actions — for example, “white crane spreads its wings” — or martial arts moves, such as “box both ears.” As you move, you breathe deeply and naturally, focusing your attention — as in some kinds of meditation — on your bodily sensations. Tai chi differs from other types of exercise in several respects. The movements are usually circular and never forced, the muscles are relaxed rather than tensed, the joints are not fully extended or bent, and connective tissues are not stretched. Tai chi can be easily adapted for anyone, from the most fit to people confined to wheelchairs or recovering from surgery.

A growing body of carefully conducted research is building a compelling case for tai chi as an adjunct to standard medical treatment for the prevention and rehabilitation of many conditions commonly associated with age. An adjunct therapy is one that’s used together with primary medical treatments, either to address a disease itself or its primary symptoms, or, more generally, to improve a patient’s functioning and quality of life.

Tai chi in motion

A tai chi class might include these parts:

Warm-up. Easy motions, such as shoulder circles, turning the head from side to side, or rocking back and forth, help you to loosen your muscles and joints and focus on your breath and body.

Instruction and practice of tai chi forms. Short forms — forms are sets of movements — may include a dozen or fewer movements; long forms may include hundreds. Different styles require smaller or larger movements. A short form with smaller, slower movements is usually recommended at the beginning, especially if you’re older or not in good condition.

Qigong (or chi kung). Translated as “breath work” or “energy work,” this consists of a few minutes of gentle breathing sometimes combined with movement. The idea is to help relax the mind and mobilize the body’s energy. Qigong may be practiced standing, sitting, or lying down.

No pain, big gains

Although tai chi is slow and gentle and doesn’t leave you breathless, it addresses the key components of fitness — muscle strength, flexibility, balance, and, to a lesser degree, aerobic conditioning. Here’s some of the evidence:

Muscle strength. Tai chi can improve both lower-body strength and upper-body strength. When practiced regularly, tai chi can be comparable to resistance training and brisk walking.

Although you aren’t working with weights or resistance bands, the unsupported arm exercise involved in tai chi strengthens your upper body. Tai chi strengthens both the lower and upper extremities and also the core muscles of the back and abdomen.

Flexibility. Tai chi can boost upper- and lower-body flexibility as well as strength.

Balance. Tai chi improves balance and, according to some studies, reduces falls. Proprioception — the ability to sense the position of one’s body in space — declines with age. Tai chi helps train this sense, which is a function of sensory neurons in the inner ear and stretch receptors in the muscles and ligaments. Tai chi also improves muscle strength and flexibility, which makes it easier to recover from a stumble. Fear of falling can make you more likely to fall; some studies have found that tai chi training helps reduce that fear.

Aerobic conditioning. Depending on the speed and size of the movements, tai chi can provide some aerobic benefits. If your clinician advises a more intense cardio workout with a higher heart rate than tai chi can offer, you may need something more aerobic as well.

Stay Well and Be Healthy!

Dr. Lucy Postolov, L.Ac. DACM Dipl