Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer therapy with few efficacious treatments.
We enrolled 70 patients with CIPN in a randomized, double-blinded, sham-controlled, cross-over trial to determine if photobiomodulation (PBM) ± physiotherapy reduced the symptoms of neuropathy compared to sham treatment. At the conclusion of follow-up, sham-arm patients could cross-over into a third arm combining PBM and physiotherapy to determine if multimodal treatment had additive effects. Treatment included 30 minute sessions 3-times weekly for 6 weeks using either PBM or sham therapy. Neuropathy was assessed using the modified total neuropathy score (mTNS) at initiation and 4, 8, and 16 weeks after initiating treatment.
Sham-treated patients experienced no significant change in mTNS scores at any point during the primary analysis. PBM patients experienced significant reduction in mTNS scores at all time points. Mean changes in mTNS score (and corresponding percent drop from baseline) for sham and PBM-group patients respectively were −0.1 (−0.7%) and −4.2 (−32.4%) at 4 weeks (p < 0.001), 0.2 (0.0%) and −6.8 (−52.6%) at 8 weeks (p < 0.001), and 0.0 (0.1%) and −5.0 (−38.8%) at 16 weeks (p < 0.001). Patients who crossed over into the PBM/PT-group experienced similar results to those treated primarily; changes in mTNS score from baseline were −5.5 (−40.6%) 4 weeks (p < 0.001), −6.9 (−50.9%) at 8 weeks (p < 0.001), and −4.9 (−35.9%) at 16 weeks (p < 0.001). The addition of physiotherapy did not improve outcomes over PBM alone.
Conclusion and relevance
Among patients with CIPN, PBM produced significant reduction in neuropathy symptoms.
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- Neurologic complications of chemotherapy and other newer and experimental approaches.in: Biller Faro Handbook of Clinical Neurology. vol. 121. Elsevier, 2014
- Chemotherapy-induced peripheral neuropathy.J. Neurol. 2002; 249: 9-17
- Chemotherapy-induced peripheral neuropathy and its impact on health-related quality of life among ovarian cancer survivors: results from the population-based PROFILES registry.Gynecol. Oncol. 2014; 135: 510-517
- Physician-assessed and patient-reported outcome measures in chemotherapy-induced sensory peripheral neurotoxicity: two sides of the same coin.Ann. Oncol. 2014; 25: 257-264
- Taxane-induced peripheral neuropathy and health-related quality of life in postoperative breast cancer patients undergoing adjuvant chemotherapy: N-SAS BC 02, a randomized clinical trial.Support Care Cancer. 2012; 20: 3355-3364
- Surviving chemotherapy for colon cancer and living with the consequences.J. Palliat. Med. 2010; 13: 1389-1391
- Efficacy of gabapentin in the management of chemotherapy-induced peripheral neuropathy: a phase 3 randomized, double-blind, placebo-controlled, crossover trial (N00C3).Cancer. 2007; 110: 2110-2118
- NCCN task force report: management of neuropathy in cancer.J. Natl. Compr. Cancer Netw. 2009; 7: S1-S26
- Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial.JAMA. 2013; 309: 1359-1367
- Pilot evaluation of Scrambler therapy for the treatment of chemotherapy-induced peripheral neuropathy.Support Care Cancer. 2015; 23: 943-951
- Electroacupuncture for chemotherapy-induced peripheral neuropathy: study protocol for a pilot multicentre randomized, patient-assessor-blinded, controlled trial.Trials. 2013; 14: 254
- Low-level laser irradiation improves functional recovery and nerve regeneration in sciatic nerve crush rat injury model.PLoS One. 2014; 9e103348
- Low-level laser therapy alleviates mechanical and cold allodynia induced by oxaliplatin administration in rats.Support Care Cancer. 2016; 24: 233-242
- Low-intensity laser therapy for painful symptoms of diabetic sensorimotor polyneuropathy: a controlled trial.Diabetes Care. 2004; 27: 921-924
- The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome.Electromyogr. Clin. Neurophysiol. 2008; 48: 229-231
- Multimodal treatment of distal sensorimotor polyneuropathy in diabetic patients: a randomized clinical trial.J. Manip. Physiol. Ther. 2014; 37: 242-252
- Effects of thai foot massage on balance performance in diabetic patients with peripheral neuropathy: a randomized parallel-controlled trial.Med. Sci. Monit. Basic Res. 2015; 20: 68-75
- Natural products and complementary therapies for chemotherapy-induced peripheral neuropathy: a systematic review.Crit. Rev. Oncol. Hematol. 2016; 998: 325-334
- The reliability and validity of a modified total neuropathy score-reduced and neuropathic pain severity items when used to measure chemotherapy-induced peripheral neuropathy in patients receiving taxanes and platinums.Cancer Nurs. 2010; 33: 173-183
- The modified total neuropathy score: a clinically feasible and valid measure of taxane-induced peripheral neuropathy in women with breast cancer.J. Support. Oncol. 2006; 4: w9-w16
- Total neuropathy score: validation and reliability study.Neurology. 1999; 53: 1660-1664
- Interpreting the clinical importance of group differences in chronic pain clinical trials: IMMPACT recommendations.Pain. 2009; 146: 238-244
- Role of low-level laser therapy in neurorehabilitation.PM R. 2010; 12: S292-S305
- cDNA microarray analysis of gene expression profiles in human fibroblast cells irradiated with red light.J. Invest. Dermatol. 2003; 120: 849-857
- Photobiomodulation directly benefits primary neurons functionally inactivated by toxins: role of cytochrome c oxidase.J. Biol. Chem. 2005; 280: 4761-4771
- Irradiation with He-Ne laser increases ATP level in cells cultivated in vitro.J. Photochem. Photobiol. B. 1995; 27: 219-223
- Increase in ←H+/e− ratio of the cytochrome c oxidase reaction in mitochondria irradiated with helium-neon laser.Biochem. Mol. Biol. Int. 1994 Oct; 34: 817-826
- Ferritin heavy chain upregulation by NF-kappaB inhibits TNFalpha-induced apoptosis by suppressing reactive oxygen species.Cell. 2004; 119: 529-542
- Induction of gadd45beta by NF-kappaB downregulates pro-apoptotic JNK signaling.Nature. 2001; 414: 308-313
- NF-kappaB protects from the lysosomal pathway of cell death.EMBO J. 2003; 22: 5313-5322
- Light supports neurite outgrowth of human neural progenitor cells in vitro: the role of P2Y receptors.J. Sel. Top. Quantum Electron. 2008; 14: 118-125
- In vitro and in vivo optimization of infrared laser treatment for injured peripheral nerves.Lasers Surg. Med. 2014; 46: 34-45
- The efficacy of low-power lasers in tissue repair and pain control: a meta-analysis study.Photomed. Laser Surg. Aug. 2004; 22: 323-329
- Statistical Power Analysis for the Behavioral Sciences.second ed. Lawrence Earlbaum, Hillsdale, NJ1988
Published online: November 22, 2016
Accepted: November 5, 2016
Received in revised form: November 1, 2016
Received: September 5, 2016
© 2016 Elsevier Inc. All rights reserved.