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--- acupuncture:evaluation:oncologie:04. neuropathie peripherique induite par chimiotherapie [28 Jan 2023 07:47]
Nguyen Johan [1.1.1. Xu 2022]
+++ acupuncture:evaluation:oncologie:04. neuropathie peripherique induite par chimiotherapie [28 Aug 2025 19:06] (Version actuelle)
Nguyen Johan [2. Overviews of Systematic Reviews]
@@ Ligne 4: / Ligne 4: @@
 ====== Chemotherapy-Induced Peripheral Neuropathy ======
-====== Neuropathie périphérique induite par chimiothérapie : évaluation de l'acupuncture ======
+====== Neuropathie périphérique induite par chimiothérapie : évaluation de l'acupuncture  ======
 | //Articles connexes//: - [[pharmacopee:evaluation:oncologie:04. neuropathie peripherique induite par chimiotherapie|pharmacopée]] - |
@@ Ligne 10: / Ligne 10: @@
 ===== Revues systématiques et méta-analyses  =====
-** GRADE certainty ratings** \\
-|⊕⊕⊕⊕|High|The authors have a lot of confidence that the true effect is similar to the estimated effect |
-|⊕⊕⊕⊖|Moderate |The authors believe that the true effect is probably close to the estimated effect|
-|⊕⊕⊖⊖|Low|The true effect might be markedly different from the estimated effect|
-|⊕⊖⊖⊖|Very low| The true effect is probably markedly different from the estimated effect|
-| ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture |
+==== Generic Acupuncture ====
-| ☆☆ | Evidence for effectiveness of acupuncture |
-| ☆ |Limited evidence for effectiveness of acupuncture |
-| Ø |No evidence or insufficient evidence |
+=== Zhao 2025 ===
-==== Generic Acupuncture ====
+Zhao Y, Cao W, Zhang H, Rong Q, He M, Wu M, Zhao Y, Yang P. The efficacy of acupuncture in the treatment of chemotherapy-induced peripheral neuropathy in cancer patients: a systematic review and meta-analysis. J Cancer Surviv. 2025 Aug 19. doi: 10.1007/s11764-025-01869-3
+^Purpose|Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect in cancer patients, often emerging within the first month of chemotherapy. Severe CIPN can disrupt daily life, necessitating chemotherapy adjustments or discontinuation, which may increase cancer mortality. No standardized treatment exists, but acupuncture is widely used in China for CIPN.This study aimed to comprehensively assess the actual efficacy of acupuncture in treating CIPN in cancer patients.|
+^Methods| We searched PubMed, Web of Science, Embase, and Cochrane Library up to October 2024 for randomized controlled trials (RCTs) on acupuncture for CIPN, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methodological quality was assessed using the Cochrane risk-of-bias tool (RoB 2.0) and the modified Jadad scale. A random-effects model was used to analyze the Effect Size (ES) and 95% Confidence Interval (CI).Data analysis was performed using RevMan 5.3 software.|
+^Results| The final analysis incorporated** 1,048 patients from 18 studies**. The results presented in the forest plot demonstrated that, when compared to the control group, acupuncture exhibited superior efficacy in improving CIPN symptoms (RR = 1.11, 95%CI [1.01,1.21]), alleviating pain (SMD = -0.93, 95%CI [-1.63,-0.22]), enhancing quality of life (QoL) (MD = - 1.14, 95%CI [- 1.97, - 0.31]), and reducing chemotherapy-related neurotoxicity (MD = - 3.34, 95%CI [- 5.24, - 1.44]). Additionally, in alleviating CIPN-related pain, simple acupuncture demonstrates superior efficacy compared to electroacupuncture.|
+^Conclusion| This study clearly demonstrates that acupuncture offers more substantial benefits to CIPN patients compared to usual care, medication, vitamin, and sham acupuncture. This research serves as a valuable reference for cancer patients, physicians, nurses, and other professional medical practitioners.|
-=== Xu 2022 ☆☆☆ ===
+=== Li 2024 ===
-|⊕⊕⊕⊖| Moderate |
+Li L, Huang Y, An C, Jing N, Xu C, Wang X, Li H, Tan T. Acupuncture in the treatment of chemotherapy-induced peripheral neuropathy: a meta-analysis and data mining. Front Neurol. 2024 Oct 29;15:1442841.  https://doi.org/10.3389/fneur.2024.1442841.
+^Backgound| The efficacy and acupoint selection of acupuncture in treating chemotherapy-induced peripheral neuropathy (CIPN) remain controversial. This study aims to explore the specific efficacy and acupoint selection of acupuncture in treating CIPN through a meta-analysis and data mining.|
+^Methods| Searching for clinical trials on acupuncture treatment for CIPN in 8 databases, evaluating its efficacy and safety through a meta-analysis, and exploring its acupoint selection through data mining.|
+^Results| The meta-analysis included **21 studies and 2,121 patients**, showing that compared with the control group, the acupuncture group could significantly improve neuropathic pain intensity (SMD = -0.66, 95% CI [-1.07, -0.25], p = 0.002), significantly reduce the NCI-CTCAE (MD = -0.29, 95%CI [-0.50, -0.08], p < 0.01), significantly reduce the FACT-NXT score (MD = 2.09, 95% CI [0.73,3.45], p < 0.05), significantly increase the motor conduction velocities (MCV) of median nerve (MD = 2.38, 95% CI [2.10, 2.67], p < 0.001), the sensory conduction velocities (SCV) of the median nerve (MD = 0.56, 95 %CI [-1.45, 2.57], p = 0.58), the SCV of the tibial nerve (MD = 1.78, 95% CI [0.50, 3.05], p < 0.01), and the SCV of sural nerves (MD = 4.60, 95% CI [0.17, 9.02], p < 0.05), as well as improving the quality of life score (MD =7.35, 95% CI [1.53, 13.18], p = 0.01). Data mining showed that the core acupoints for acupuncture treatment of CIPN were LI4, ST36, LI11, LR3, and SP6.|
+^Conclusion| Acupuncture can improve the neuropathic pain intensity, the intensity of the CIPN, MCV of the median nerve, SCV of the tibial nerve and peroneal nerve, quality of life, and has good safety in CIPN patients. LI4 (Hegu), ST36 (Zusanli), LI11 (Quchi), LR3 (Taichong), and SP6 (Sanyinjiao) are the core acupuncture points for treating CIPN, and this protocol has the potential to become a supplementary treatment for CIPN.¬|
+=== Ronconi 2024 ===
+Ronconi G, Gatto DM, Codazza S, Ariani M, Martire E, Cerretti L, Carella V, Coraci D, Ferriero G, Ferrara PE. Conservative non-pharmacological treatments for chemotherapy-induced peripheral neuropathies in women treated for breast cancer: a systematic review. Eur J Phys Rehabil Med. 2024 Jun;60(3):505-513.  https://doi.org/10.23736/S1973-9087.24.08197-8
+^Introduction|Over the last few decades, the use of neo/adjuvant therapies has significantly increased the number of breast cancer survivors who experience chemotherapy-induced peripheral neuropathy (CIPN). To date, few, low-efficacy, pharmacological remedies exist to manage this side effect. For this reason, alternative treatments are increasingly being investigated as possible strategies to prevent or promote faster recovery from CIPN. In this review we aimed to provide an overview of the literature evidence regarding all the non-pharmacological and rehabilitative interventions for patients affected by CIPN secondary to breast cancer care.|
+^Evidence acquisition| A comprehensive literature search was conducted on PubMed, Scopus and Web of Science and included a total of 1895 patients (1528 with breast cancer) with a wide range of CIPN (motor, sensory and autonomic neuropathies) and chemotherapy treatments (e.g., Taxanes, Platins, Vinca alkaloids or monoclonal antibody drugs).|
+^Evidence synthesis| Of the initial 1108 hits, only 25 studies - describing different treatment modalities for peripheral neuropathies - were finally included in the qualitative synthesis. Most studies focused on acupuncture, physiotherapy, cryotherapy, and yoga.|
+^Conclusions| There is still controversial evidence on conservative non-pharmacological interventions for the management of CIPN symptoms. We believe however that moderate exercise, as well as all types of stress reducing activities like sport, yoga and mindfulness, should be encouraged in cancer patients for their positive effect on global physical and psychological health. Further studies of higher methodological quality are needed to determine the best conservative approach to CIPN.|
+=== D'Souza 2023 ===
+D'Souza RS, Alvarez GAM, Dombovy-Johnson M, Eller J, Abd-Elsayed A. Evidence-Based Treatment of Pain in Chemotherapy-Induced Peripheral Neuropathy. Curr Pain Headache Rep. 2023 May;27(5):99-116. https://doi.org/10.1007/s11916-023-01107-4
+^Purpose of review|Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and often painful condition that occurs after administration of chemotherapeutic agents. The primary objective of this systematic review was to appraise the literature on conservative, pharmacological, and interventional treatment options for CIPN pain. |
+^Recent findings| There is level I evidence supporting modest to moderate improvement in CIPN pain from duloxetine treatment, as well as short-term modest improvement from physical therapy and **acupuncture**. Although opioid and cannabis administration may provide short-term modest improvement, administration is commonly limited by side effects. Generally, most studies reported no clinical benefit from yoga, topical neuropathic agents, gabapentinoids, and tricyclic antidepressants. Evidence is currently equivocal for scrambler therapy and transcutaneous electrical nerve stimulation. Finally, evidence on neuromodulation options is limited to mostly case reports/series and one observational study highlighting moderate improvement with auricular nerve stimulation. This systematic review provides an overview of conservative, pharmacologic, and interventional treatment modalities for CIPN pain. Furthermore, it provides a level of evidence and degree of recommendation based on the United States Preventive Services Task Force (USPSTF) criteria for each specific treatment modality. |
+=== Papadopoulou 2023 ===
+Papadopoulou M, Stamou M, Bakalidou D, Moschovos C, Zouvelou V, Zis P, Tzartos J, Chroni E, Michopoulos I, Tsivgoulis G. Non-pharmacological Interventions on Pain and Quality of Life in Chemotherapy Induced Polyneuropathy: Systematic Review and Meta-Analysis. In Vivo. 2023 Jan-Feb;37(1):47-56.  https://doi.org/10.21873/invivo.13053
+^Background/aim|Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment, resulting in pain, numbness, instability, and thus affecting quality of life (QoL), occasionally leading to discontinuation of chemotherapy. Pharmacological treatments are not sufficient. Non-pharmacological interventions (NPIs) have also been tried. This study aimed to systematically review the efficacy of NPIs on pain and QoL in patients suffering from CIPN.|
+^Materials and methods|The databases searched were Pubmed, Cohrane, and Scopus for randomized controlled trials (RCTs) published in the last 5 years (2017-2022). Studies were considered eligible, if they assessed adult patients suffering from CIPN because of any chemotherapeutic drug for any type and any stage of cancer and if study protocols included non-pharmacological intervention with a structured protocol.|
+^Results|A total of 1,496 records were identified. Finally, 10 RCTs including 495 patients (253 in the intervention group and 242 in the control group) were included for meta-analysis. Intervention protocols included **acupuncture (n=6)**, exercise (n=3), and yoga (n=1). NPIs significantly reduced neuropathic pain. However, the effect on QoL was not significant.|
+^Conclusion|NPIs are beneficial in the treatment of pain in patients with CIPN but their impact on QoL is not statistically supported. Larger sample sizes, more homogenous in outcome measures and interventions are needed to further explore NPIs' efficacy on CIPN symptoms.|
+=== Pei 2023 ===
+Pei LX, Yi Y, Guo J, Chen L, Zhou JY, Wu XL, Sun JH, Chen H. The effectiveness and safety of acupuncture/electroacupuncture for chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis. Acupunct Med. 2023 Apr;41(2):73-85.  https://doi.org/10.1177/09645284221076512
+^Objective| Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting adverse eﬀect of anticancer agents with virtually no effective treatment. Safe and effective therapies are needed urgently. Acupuncture shows therapeutic possibilities in this regard but needs to be further evaluated.|
+^Methods| A systematic search was conducted in seven databases from their inception to April 2020. Randomized controlled trials (RCTs) focused on acupuncture/electroacupuncture (EA) for the treatment of CIPN were included. Revman 5.3 software was used for meta-analysis if there was no significant heterogeneity. Otherwise, qualitative analysis was utilized.|
+^Results|**Nine studies involving 582 patients** were included in this review. Most of the studies exhibited unclear risk of bias because some details were not mentioned. As the clinical heterogeneity was significant, qualitative analysis was performed to describe nerve conduction velocity, effective rate for motor neuropathy, pain scores, quality of life and adverse events. Meta-analysis was performed on four studies to analyze the effective rate for sensory neuropathy due to inconspicuous heterogeneity. The results indicated that acupuncture may generate a better effect on sensory neuropathy than vitamin B (risk ratio = 1.60, 95% confidence interval = 1.31-1.95, I2 = 0%, p < 0.00001). The efficacy of EA plus glutathione (GSH) appeared to be better than that of GSH alone in alleviating sensory neurotoxicity and in improving nerve conduction velocity. Acupuncture plus methylcobalamin showed more favorable effects than methylcobalamin alone in relieving neuralgia, restoring nerve conduction velocity and improving quality of life. In terms of pain relief and improved CIPN-specific quality of life, acupuncture plus standard care was better than standard care alone. In terms of pain relief, EA was more effective than usual care.|
+^Conclusion|Acupuncture may be effective and safe in the treatment of CIPN according to the analyzed studies. However, more studies with higher methodological quality are warranted in order to be able to draw firmer conclusions. Future rigorous RCTs will be necessary to confirm the effectiveness and safety of acupuncture for CIPN.|
+== Zhang 2023 ==
+Zhang X, Wang A, Wang M, Li G, Wei Q. Non-pharmacological therapy for chemotherapy-induced peripheral neurotoxicity: a network meta-analysis of randomized controlled trials. BMC Neurol. 2023 Dec 11;23(1):433.  https://doi.org/10.1186/s12883-023-03485-z
+^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.|
+=== Xu 2022 ⊕⊕⊕ ===
+|GRADE|⊕⊕⊕⊖| Moderate |
 Xu Z, Wang X, Wu Y, Wang C, Fang X. The effectiveness and safety of acupuncture for chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis. Front Neurol. 2022 Oct 3;13:963358.  https://doi.org/10.3389/fneur.2022.963358
-^Objectives| This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of acupuncture on chemotherapy-induced peripheral neuropathy (CIPN).|
+^ Objectives  | This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of acupuncture on chemotherapy-induced peripheral neuropathy (CIPN).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      |
-^Methods|We searched for relevant randomized controlled trials (RCTs) in PubMed, Cochrane Library, and Embase databases from their inception to 1 April 2022. The Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx), Brief Pain Inventory-Short Form (BPI-SF), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 (EORTC QLQ-C30), Numerical Rating Scale (NRS), and adverse events were the outcome measures. All studies had at least one of these outcome measures. Mean differences (MDs) with 95% confidence intervals (CIs) were assessed in the meta-analysis using the RevMan 5.3 software.|
+^ Methods     | We searched for relevant randomized controlled trials (RCTs) in PubMed, Cochrane Library, and Embase databases from their inception to 1 April 2022. The Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx), Brief Pain Inventory-Short Form (BPI-SF), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 (EORTC QLQ-C30), Numerical Rating Scale (NRS), and adverse events were the outcome measures. All studies had at least one of these outcome measures. Mean differences (MDs) with 95% confidence intervals (CIs) were assessed in the meta-analysis using the RevMan 5.3 software.                                                                                                                                                                         |
-^Results| **Five studies** were included in the analysis. The results showed that acupuncture and placebo acupuncture were not significantly different in reducing chemotherapy-induced neurotoxicity and functional disability (random-effects estimates; MD: 4.30; 95% CI: -0.85~9.45; P = 0.10; I2 = 74%). Acupuncture was better than placebo acupuncture in reducing pain severity and pain interference with patients' daily function (fixed-effect estimates; MD: -1.14; 95% CI: 1.87 to -0.42; P = 0.002; I2 = 13%). Acupuncture was not significantly different from placebo acupuncture in relieving CIPN symptoms (MD: -0.81; 95% CI: -2.02 to 0.40, P = 0.19). Acupuncture improved quality of life better than placebo acupuncture (MD: 10.10; 95% CI: 12.34 to 17.86, P = 0.01). No severe adverse events were recorded in all five studies.|
+^ Results     | **Five studies** were included in the analysis. The results showed that acupuncture and **placebo acupuncture** were not significantly different in reducing chemotherapy-induced neurotoxicity and functional disability (random-effects estimates; MD: 4.30; 95% CI: -0.85~9.45; P = 0.10; I2 = 74%). Acupuncture was better than **placebo acupuncture** in reducing pain severity and pain interference with patients' daily function (fixed-effect estimates; MD: -1.14; 95% CI: 1.87 to -0.42; P = 0.002; I2 = 13%). Acupuncture was not significantly different from **placebo acupuncture** in relieving CIPN symptoms (MD: -0.81; 95% CI: -2.02 to 0.40, P = 0.19). Acupuncture improved quality of life better than **placebo acupuncture** (MD: 10.10; 95% CI: 12.34 to 17.86, P = 0.01). No severe adverse events were recorded in all five studies.  |
-^Conclusion|This meta-analysis suggests that acupuncture may be more effective and safer in reducing pain severity and pain interference with patients' daily function than placebo acupuncture. Additionally, acupuncture may improve the quality of life of patients with CIPN. However, large sample size studies are needed to confirm this conclusion.|
+^ Conclusion  | This meta-analysis suggests that acupuncture may be more effective and safer in reducing pain severity and pain interference with patients' daily function than placebo acupuncture. Additionally, acupuncture may improve the quality of life of patients with CIPN. However, large sample size studies are needed to confirm this conclusion.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
-=== Liu 2021 ===
+=== Liu 2021 ☆===
@@ Ligne 55: / Ligne 107: @@
 ^ Conclusion|The use of acupuncture in the management of CIPN is safe and effective. The most used acupoints for CIPN are LI4, LI11, ST36, EX10 (Bafeng), and EX-UE 9 (Baxie). |
-=== Hwang 2020 ===
+=== Hwang 2020 ⊕⊕ ===
+|GRADE |⊕⊕⊖⊖|Low|
 Hwang MS, Lee HY, Choi TY, Lee JH, Ko YS, Jo DC, Do K, Lee JH, Park TY. A systematic review and meta-analysis of the efficacy of acupuncture and electroacupuncture against chemotherapy-induced peripheral neuropathy. Medicine (Baltimore). 2020;99(17):e19837.   {{:medias securises:acupuncture:evaluation:oncologie:hwang-208843.pdf|[208843]}}. [[http://dx.doi.org/10.1097/MD.0000000000019837|doi]]
@@ Ligne 140: / Ligne 194: @@
 ^Results | From 3989 retrieved papers, 8 relevant papers were identified. One was an experimental study which showed that electroacupuncture suppressed CIPN pain in rats. In addition, there were 7 very heterogeneous clinical studies, **1 controlled randomised study using auricular acupuncture, 2 randomized controlled studies using somatic acupuncture**, and 3 case series/case reports which suggested a positive effect of acupuncture in CIPN. Conclusions. Only one controlled randomised study demonstrated that acupuncture may be beneficial for CIPN. All the clinical studies reviewed had important methodological limitations. |
 ^Conclusions | Further studies with robust methodology are needed to demonstrate the role of acupuncture for treating CIPN resulting from cancer treatment.|
+==== Special Acupuncture Techniques  ====
+=== Comparison of Acupuncture techniques ===
+== Li 2025 ==
+Li Y, Liu S, Qiao HF. Acupuncture-moxibustion for chemotherapy-induced peripheral neuropathy: A systematic review and network meta-analysis. World J Acupunct Moxibustion. 2025 Jul;35(3):197-207. https://doi.org/10.1016/j.wjam.2025.06.001.
+^Background| Chemotherapy-induced peripheral neuropathy (CIPN) is a common neurotoxic reaction for patients undergoing anticancer regimens. More and more studies show that acupuncture-moxibustion plays a positive role in the management and prevention of CIPN. |
+^Objective| To evaluate the clinical effect of acupuncture-moxibustion in patients with CIPN, with a focus on assessing its effectiveness on improving treatment response rates, alleviating pain, enhancing quality of life (QoL), and improving nerve conduction. Additionally, the study compares the differences in clinical effectiveness among various acupuncture therapies for CIPN management. |
+^Methods| Six databases (PubMed, Embase, Cochrane Library, Web of Science, OVID, and China National knowledge infrastructure [CNKI]) were searched from earliest available dates to December 1, 2024, and only randomized controlled trials (RCTs) containing relevant search terms were included. Network meta-analysis of the RCT data were conducted to assess the effective rate of the treatment as the primary outcome. Nerve conduction, pain scores, and QoL were assessed as secondary outcomes. The version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to examine methodological quality, and Stata 15.1 was used to take network meta-analysis. |
+^Results| A total of **34 RCTs involving 2039 participants** and 9 acupuncture-moxibustion therapies were included. The network meta-analysis evaluated the effect of different acupuncture therapies across four outcomes: effective rate, pain scores, QoL, and nerve conduction. For effective rate, electroacupuncture combined with moxibustion ranked first with a surface under the cumulative ranking curve (SUCRA) value of 62.9 %, followed by acupoint application (56.9 %) and moxibustion (52.3 %). Electroacupuncture combined with moxibustion had the highest effective rate compared to standard of care treatments (odds ratio [OR] = 1.62, 95 % confidence interval [CI] −5.18 to 8.43). For alleviating pain, auricular acupressure had the highest SUCRA value (85.9 %), while electroacupuncture and electroacupuncture combined with three-edged needle ranked second (63.4 %) and third (51.0 %), respectively. Auricular acupressure significantly reduced pain (SMD= −1.73, 95 % CI −3.54 to 0.08). For QoL, warming needle ranked first (SUCRA= 92.0 %), followed by electroacupuncture (48.7 %) and filiform needle (43.0 %). Warming needle significantly improved QoL scores (SMD= −0.75, 95 % CI −1.66 to 0.15). For nerve conduction, electroacupuncture combined with three-edged needle had the highest SUCRA value (100 %), while moxibustion and filiform needle ranked second (65.3 %) and third (39.2 %), respectively. Electroacupuncture combined with three-edged had the best neuroprotective effect (SMD = 1.85, 95 % CI 1.23 to 2.47). |
+^Conclusion| Network meta-analysis based on the primary outcome (effective rate) suggests that electroacupuncture combined with moxibustion seems to be the optimal acupuncture therapy for chemotherapy-induced peripheral neuropathy (CIPN). Secondary outcomes exhibited considerable heterogeneity: auricular acupressure demonstrated superior efficacy in pain relief, electroacupuncture combined with three-edged needle showed greater advantages in improving nerve conduction function, while warm needling was associated with more significant improvements in QoL. Given the variability in interventions across different outcome measures and the methodological limitations of included studies, the current evidence requires cautious interpretation|
+== Yeh 2024 ==
+Yeh ML, Liao RW, Yeh PH, Lin CJ, Wang YJ. Acupuncture-related interventions improve chemotherapy-induced peripheral neuropathy: A systematic review and network meta-analysis. BMC Complement Med Ther. 2024 Aug 19;24(1):310.  https://doi.org/10.1186/s12906-024-04603-1
+^Backgound| The previous effects of acupuncture-related interventions in improving chemotherapy-induced peripheral neuropathy (CIPN) symptoms and quality of life (QoL) remain unclear in terms of pairwise comparisons.|
+^Aims| This systematic review and network meta-analysis aimed to determine the hierarchical effects of acupuncture-related interventions on symptoms, pain, and QoL associated with CIPN in cancer patients undergoing chemotherapy.|
+^Methods| Nine electronic databases were searched, including PubMed, Embase, Cochrane Library, EBSCO, Medline Ovid, Airiti Library, China National Knowledge Infrastructure (CNKI), China Journal full-text database (CJFD), and Wanfang. Medical subject heading terms and text words were used to search for eligible randomized controlled trials published from database inception to May 2023.|
+^Results| A total of **33 studies involving 2,027 participants** were included. Pairwise meta-analysis revealed that acupuncture-related interventions were superior to usual care, medication, or dietary supplements in improving CIPN symptoms, CIPN pain, and QoL. Furthermore, network meta-analysis indicated that acupuncture plus electrical stimulation (acupuncture-E) had the greatest overall effect among the various interventions. The surface under the cumulative ranking curve (SUCRA) revealed that acupuncture-E ranked the highest in improving CINP symptoms. Acupuncture alone was most effective in reducing CIPN pain, and acupuncture plus moxibustion (acupuncture-M) ranked highest in enhancing QoL.|
+^Conclusion| This finding suggests that acupuncture-related interventions can provide patients with benefits in improving CIPN symptoms, pain, and QoL. In particular, acupuncture-E could be the most effective approach in which the provided evidence offers diverse options for cancer patients and healthcare professionals.|
+^Implication for the profession and/or patient care| These findings provide valuable insights into the potential benefits of acupuncture-related interventions for managing symptoms, pain, and QoL associated with CIPN in patients undergoing chemotherapy. Among the various interventions studied, overall, acupuncture-E had the most significant impact and was effective for a minimum duration of 3 weeks. On the other hand, transcutaneous electrical acupoint/nerve stimulation (TEAS) was identified as a noninvasive and feasible alternative for patients who had concerns about needles or the risk of bleeding. It is recommended that TEAS interventions should be carried out for a longer period, preferably lasting 4 weeks, to achieve optimal outcomes.|
+== Zhang 2023 ==
+Zhang T, Zhang Q, Zhu P, Sun W, Ding Z, Hu L. The Efficacy of Acupuncture in the Treatment of Chemotherapy-Induced Peripheral Neuropathy: A Network Meta-Analysis. Altern Ther Health Med. 2023 Nov;29(8):898-906. PMID: 37708563.
+^Background| Chemotherapy-induced peripheral neuropathy (CIPN), one of the most common adverse events associated with chemotherapy, may affect efficacy because of the interruption of chemotherapy or change of regimen in severe cases, and may even increase cancer mortality. Relevant data supports the evidence that acupuncture can treat pain and sensory abnormalities. However, choosing the most effective acupuncture therapy is difficult because of the lack of evidence-based medicine and comparisons between different acupuncture therapies for treating CIPN. The aim of this study was to use a network meta-analysis (NMA) to evaluate the efficacy of different acupuncture therapies for CIPN.|
+^Methods| We searched Embase, PubMed, Web of Science, The Cochrane Library, The Chinese Journal Full Text Database, Chinese Biomedical Literature Database, and WanFang Database for randomized controlled trials (RCTs) of acupuncture for CIPN. The search period was from the creation of the relevant library to August 10, 2023. A total of 2 investigators independently performed literature screening, data extraction, and risk for bias evaluation. Stata 14.0 software (StataCorp LLC, College Station, Texas USA), was used for the NMA.|
+^Results| A total of 13 eligible RCTs involving 746 patients and 6 acupuncture therapies were included in the study. The NMA results showed that electroacupuncture was superior to moxibustion, manual acupuncture, acupoint injection and Western medicine in improving the total effective rate of treatment of CIPN; electroacupuncture + moxibustion was better than manual acupuncture, acupoint injection, and Western medicine. Manual acupuncture's total effective rate was better than Western medicine. However, electroacupuncture was the most effective treatment for CIPN according to the surface under the cumulative ranking curve (SUCRA) ranking.|
+^Conclusion| After a comprehensive evaluation of 6 acupuncture therapies for treating CIPN based on NMA, electroacupuncture may be the best option for treating CIPN. However, would be more convincing to get evidence from more RCTs.|
 ==== Special Clinical Forms ====
@@ Ligne 164: / Ligne 251: @@
-===== Overviews of Systematic Reviews =====
+===== Overviews of systematic reviews =====
+==== Yeh 2025 ====
+Yeh ML, Hsu CC, Lin M, Lin CJ, Lin JG. Effects of Acupuncture-related Intervention on Chemotherapy-Induced Peripheral Neuropathy and Quality of Life: An Umbrella Review. Complement Ther Med. 2025 Feb 1:103131.  https://doi.org/10.1016/j.ctim.2025.103131
+^Backgound| Numerous studies have explored the role of acupuncture-related treatments in alleviating chemotherapy-induced peripheral neuropathy (CIPN) and improving the quality of life for patients with cancer, resulting in mixed findings. This umbrella review aimed to synthesize existing systematic reviews (SRs) to deliver an updated assessment of the certainty of evidence concerning the effects of acupuncture-related treatments on CIPN and quality of life among a diverse group of patients with cancer.|
+^Methods| This umbrella review considered eligible SRs published on one of nine electronic databases between inception and August 2024. It included adult patients with cancer of any stage who were undergoing chemotherapy. Interventions encompassed acupuncture, either alone or with electrical stimulation or moxibustion, and transcutaneous electrical acupoint/nerve stimulation (TEAS). The outcomes analyzed were changes in CIPN, nerve conduction velocity (NCV), and quality of life.|
+^Results| The outcomes were evaluated using data obtained from **14 SRs** that demonstrated moderate to high methodological and reporting quality. The findings showed that acupuncture (either alone or combined with electrical stimulation) and TEAS effectively alleviated CIPN symptoms, reduced CIPN pain, improved NCV, and enhanced quality of life.|
+^Conclusion| The findings of this umbrella review indicate that these benefits were usually noticeable by the second week of treatment, persisted until the sixth week, and then gradually declined. Sensory nerve recovery occurred more rapidly than motor nerve recovery, often within 1.5 weeks. Although acupuncture combined with moxibustion or acupressure also enhanced patient outcomes, there was insufficient information available for further study analysis.|
+==== Ye 2025 ====
+Ye AL, Abdi S. Beyond p-values: a cross-sectional umbrella review of chemotherapy-induced peripheral neuropathy treatments. Front Pain Res (Lausanne). 2025 Mar 19;6:1564662.  https://doi.org/10.3389/fpain.2025.1564662
+^Introduction|Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of neurotoxic chemotherapy agents, significantly impacting the daily lives of many cancer survivors. Despite thousands of articles published on CIPN, we remain no closer to a successful treatment regimen for the condition. In recent years, several new clinical trials and systematic reviews have been published, many exploring nonpharmaceutical interventions, prompting the need for a comprehensive synthesis of this emerging evidence.|
+^Methods| We conducted an umbrella review to identify and appraise the **19 systematic reviews (SRs)** published in 2023 that examined randomized controlled trials (RCTs) for established CIPN treatment. We focused our analysis on the three most researched treatment options: oral drugs, exercise, and acupuncture. RCTs not previously synthesized together were reviewed, and effect size analyses were performed to allow readers to interpret the existing literature beyond binary p-values.|
+^Results| Our analysis of RCTs revealed the following key findings. For cancer survivors with CIPN after completing chemotherapy, serotonin-norepinephrine reuptake inhibitors (SNRIs) as well as **acupuncture** provided at least short-term relief for pain and sensory symptoms. For patients with CIPN who were actively undergoing chemotherapy, home-based balance and strength training exercises appeared to alleviate symptoms. Effect size analyses highlighted variability in treatment responses, underscoring the limitations of relying solely on p-values to assess intervention efficacy.|
+^Discussion|Through an umbrella review approach, we demonstrate that SRs are often less systematic than expected. None of the 19 SRs captured all relevant RCTs within their search timeframe. However, by cross-referencing SRs, we identified 41 RCTs across 42 publications, illustrating the feasibility of an umbrella review approach to uncover relevant trials. Furthermore, many SRs exhibited methodological concerns that limit the interpretability of their findings. Finally, we discuss multiple opportunities for refining methods and reporting in future CIPN treatment trials.|
+==== Shi 2023 ====
+Shi H, Yuan X, Fan W, Yang X, Liu G. An umbrella review of the evidence to guide decision-making in acupuncture therapies for chemotherapy-induced peripheral neuropathy. J Cancer Res Clin Oncol. 2023 Nov;149(17):15939-15955.  https://doi.org/10.1007/s00432-023-05369-8
+^Background| Acupuncture therapy is believed to have therapeutic potential for patients suffering from chemotherapy-induced peripheral neuropathy (CIPN). This umbrella review aims to summarize and evaluate the evidence from current systematic reviews/meta-analyses (SRs/MAs) on the effectiveness of acupuncture treatment for CIPN.|
+^Methods| We conducted a comprehensive search in eight electronic databases for SRs/MAs that included RCTs on acupuncture treatment for CIPN. Two separate researchers independently evaluated the methodological quality, reporting quality, and evidence quality of the SRs/MAs that were included in the study. Additionally, we examined the extent of overlap among the included RCTs by calculating the corrected covered area (CCA). Furthermore, we assessed the dependability of the effect sizes by conducting excess significance tests. We conducted a quantitative synthesis of all RCTs included in the SRs/MAs to obtain objective and updated conclusions. Furthermore, we also conducted an analysis of the acupuncture points used in RCTs.|
+^Results| This umbrella review includes **9 SRs/MAs**, and their methodological quality, risk of bias, reporting quality, and evidence quality were all deemed unsatisfactory. Out of the 9 SRs/MAs, 28 RCTs were included, with a total CCA of 25.4%, indicating a high degree of overlap. The test of super-significance did not yield any significant results. Our updated meta-analysis suggests that CIPN patients can benefit from acupuncture therapy, as indicated by effectiveness in measures including BPI-SF, VAS, FACT-NTX, NRS, SCV, and NCI-CTCAE. Egger's test and sensitivity analysis demonstrate the reliability and stability of this conclusion. The commonly used acupuncture points in the current RCTs include ST36, LI11, LI4, LR3, and SP6.|
+^Conclusion| Based on the existing evidence, acupuncture is effective and safe for patients with CIPN, as it can significantly improve effective rate, pain symptoms, quality of life, and nerve conduction velocity. However, given the low quality of current evidence, we should be cautious in interpreting this conclusion.|
@@ Ligne 318: / Ligne 435: @@
   - **Acudoc2**: Base de données du centre de documentation du GERA. ECR non inclus dans les autres sources citées.
   - **Xu 2022** : Xu Z, Wang X, Wu Y, Wang C, Fang X. The effectiveness and safety of acupuncture for chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis. Front Neurol. 2022 Oct 3;13:963358. https://doi.org/10.3389/fneur.2022.963358 (n=5).
-    - **Chien 2019**: Chien TJ, Liu CY, Fang CJ, Kuo CY. The Efficacy of Acupuncture in Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Meta-Analysis. Integr Cancer Ther. 2019.   [201982].
+   - **Chien 2019**: Chien TJ, Liu CY, Fang CJ, Kuo CY. The Efficacy of Acupuncture in Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Meta-Analysis. Integr Cancer Ther. 2019.   [201982].
   - **Li 2019**: Li K, Giustini D, Seely D. A systematic review of acupuncture for chemotherapy-induced peripheral neuropathy. Curr Oncol. 2019;26(2):e147–e154.   [202648].
   - **Oh 2018** : Oh PJ, Kim YL. [Effectiveness of Non-Pharmacologic Interventions in Chemotherapy Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis]. J Korean Acad Nurs. 2018;48(2):123-142. [158610].
@@ Ligne 347: / Ligne 464: @@
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 | :::   | Zhang SQ, Wu TT, Zhang HS, Yang Y, Jiang HY, Cao SC, Xie F, Xia XT, Lü JQ, Zhong Y. Effect of electroacupuncture on chemotherapy-induced peripheral neuropathy in patients with malignant tumor: a single-blinded, randomized controlled trial. Journal of TCM. 2017;37(2):179-84.   [198642].                                                                                                                                                                          | Chien 2019                                                            |
-^ 2016  | Greenlee H, Crew KD, Capodice J, Awad D, Buono D, Shi Z, Jeffres A, Wyse S, Whitman W, Trivedi MS, Kalinsky K, Hershman DL. Randomized sham-controlled pilot trial of weekly electro-acupuncture for the prevention of taxane-induced peripheral neuropathy in women with early stage breast cancer. Breast Cancer Res Treat. 2016;156(3):453-64.   [190384].                                                                                                           | Xu 2022, Chien 2019, exclu de Li 2019 (prévention et non traitement)  |
+^ 2016  | Greenlee H, Crew KD, Capodice J, Awad D, Buono D, Shi Z, Jeffres A, Wyse S, Whitman W, Trivedi MS, Kalinsky K, Hershman DL. Randomized sham-controlled pilot trial of weekly electro-acupuncture for the prevention of taxane-induced peripheral neuropathy in women with early stage breast cancer. Breast Cancer Res Treat. 2016;156(3):453-64.   [190384]. https://doi.org/10.1007/s10549-016-3759-2                                                                 | Xu 2022, Chien 2019, exclu de Li 2019 (prévention et non traitement)  |
 |       | Xiong Zhi-Feng, Wang Ting, Gan Lin, Ran Jun, Min Jie, Lu Gang. Clinical efficacy of acupoint injection for chemotherapy-induced peripheral neuropathy of patients with breast cancer. World Journal of Acupuncture-Moxibustion. 2016;26(2):20.   [189265].                                                                                                                                                                                                              | Acudoc2                                                               |
 ^ 2013  | Rostock M, Jaroslawski K, Guethlin C, Ludtke R, Schröder S, Bartsch HH. Chemotherapy-induced Peripheral Neuropathy in Cancer Patients: A Four-Arm Randomized Trial on the Effectiveness of Electroacupuncture. Evid Based Complement Alternat Med. 2013.   [169708]. [[https://doi.org/10.1155/2013/349653|DOI]]                                                                                                                                                        | Chien 2019,  Li 2019, Oh 2018, Brami 2016, Lau 2016                   |
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