Background & Aims

Chemotherapy-induced peripheral neuropathy (CIPN) is a major concern in cancer survivors. CIPN is associated with peripheral neuroinflammation, central nervous system changes, and autonomic dysregulation that facilitate a pronociceptive modulation state. Transcutaneous auricular vagus nerve stimulation (taVNS) is a form of noninvasive stimulation that is known to influence the activity of pathways involved in CIPN; thus, taVNS may be a useful intervention for CIPN. However, it is important to engage patients with CIPN to determine overall feasibility and their interest in taVNS research before developing large scale clinical trials. Thus, the purpose of this survey study was to assess the interest of people with CIPN for taVNS research.

Methods

Patients receiving care at a university-based cancer institute were recruited via phone calls and in-clinic flyers. Inclusion criteria included any patients who reported having pain or paresthesia in the hands or feet that had developed after chemotherapy treatment. The survey was administered electronically via Qualtrics using a link or QR code. Participants answered questions designed to characterize their CIPN symptoms and severity, current pain management strategies used, and interest in participating in taVNS research and expectations of CIPN symptom relief. This research was supported by pilot funding from the National Institutes of Health, the National Center of Neuromodulation for Rehabilitation, the National Center for Complementary and Integrative Health, the National Institute on Deafness and Other Communication Disorders, and the National Institute of Neurological Disorders and Stroke (NIH/NICHD Grant Number P2CHD086844).

Results

Forty participants completed the survey, with 20% self-identifying their race as Black or other, 68% identifying of Hispanic or Latino ethnicity, and 65% identifying as female. As a group, they had moderate to high symptom severity with mean scores between 5-7 for pain and neuropathic symptoms (i.e., numbness, tingling, burning) on a scale of 0-10. Most participants used medication to manage symptoms, with 50% using gabapentin, 11% using duloxetine, and 13% using opioids. The most used nonpharmacological tools were massage (53%) and exercise (55%), with only 9% using TENS and 17% using thermal modalities. Notably, 77% of participants expressed “moderate” to “a great deal” of interest in participating in taVNS research which was greater than the 55% who thought that it would be helpful for them. There were no differences between racial, ethnic, or gender groups (p > 0.10) regarding interest in participating in taVNS research.

Conclusions

Although persons from racial and ethnic minority groups are known to participate in clinical research at lower rates than nonminority persons, in this diverse sample of patients with CIPN there was widespread interest for participation in taVNS research. The fact that interest in participation exceeded their expectations for benefit may be reflective of the current lack of effective treatment options for CIPN.

References

1.Colvin LA. Chemotherapy-induced peripheral neuropathy: where are we now? Pain. 2019;160 Suppl 1(Suppl 1):S1-S10.
2.Nemenov MI, Alaverdyan H, Burk C, et al. Characterization of Patients With and Without Painful Peripheral Neuropathy After Receiving Neurotoxic Chemotherapy: Traditional Quantitative Sensory Testing vs C-Fiber and Adelta-Fiber Selective Diode Laser Stimulation. J Pain. 2022;23(5):796-809.
3.Burgess J, Ferdousi M, Gosal D, et al. Chemotherapy-Induced Peripheral Neuropathy: Epidemiology, Pathomechanisms and Treatment. Oncol Ther. 2021;9(2):385-450.
4.Farmer AD, Strzelczyk A, Finisguerra A, et al. International Consensus Based Review and Recommendations for Minimum Reporting Standards in Research on Transcutaneous Vagus Nerve Stimulation (Version 2020). Front Hum Neurosci. 2020;14:568051.
5.Courties A, Deprouw C, Rousseau A, et al. Transcutaneous vagus nerve stimulation in erosive hand osteoarthritis: protocol for the randomised, double-blind, sham-controlled ESTIVAL trial. BMJ Open. 2022;12(3):e056169.

Presenting Author

Marlon Wong

Poster Authors

Marlon Wong

PhD

University of Miami

Lead Author

Jessica Bolanos

PT

University of Miami

Lead Author

Peter Hosein

MD

University of Miami

Lead Author

Eva Widerstrom-Noga

Miami Project to Cure paralysis, Miller School of medicine, Univ of Miami

Lead Author

Frank Penedo

PhD

University of Miami

Lead Author

Annemay Lelis

University of Miami

Lead Author

Denise Pereira

MD

University of Miami

Lead Author

Juan Gonzalez

University of Miami, Department of Physical Therapy, APReCIAT Lab

Lead Author

Gabriel Gonzalez

The University of Miami

Lead Author

Chelsea Miller

PT

University of Miami

Lead Author

Teresa Glynn

University of Miami

Lead Author

Lisa McTeague

PhD

Medical University if South Carolina

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Cancer Pain & Palliative Care