Background & Aims
Chemo-Induced Peripheral Neuropathy (CIPN) is a debilitating nerve damage condition that results from the toxic effects of anti-neoplastic drugs, affecting 30%-60% of patients. Symptoms include pain, paresthesia, and loss of sensation in the extremities affecting balance and mobility, fine motor ability, and quality of life. To date, no treatment has proven sufficiently effective to ameliorate CIPN symptoms. Our study aims to assess the feasibility and effectiveness of a sensory retraining physical therapy treatment program. The therapeutic rationale is to target the sensory system, through task-specific top-down training of sensory ability and capacity.
Methods
A prospective pilot feasibility trial (ClinicalTrials.gov registration: NCT05382520), conducted in an outpatient cancer clinic, studied the feasibility and effectiveness of three 45-minute sessions, a week apart, of explicit sensory retraining of the lower extremities in individuals with CIPN in the chronic stage. Participants were given a home training program and completed a training log. A 0-25 score questionnaire assessed their satisfaction with the treatment. Primary outcome measures included the Visual Analogue Scale (VAS-max and week average), the Treatment Induced Neuropathy Assessment Scale (TNAS), and the Timed Up & Go test (TUG) and were assessed twice pre-treatment, during and post-treatment. Secondary outcome measures included Semmes Weinstein Monofilaments, Lower Extremity Position Test, and Fullerton Assessment Balance Scale. Statistical analysis was calculated using the Wilcoxon rank test. Significance was set at p?0.05 with a correction for multiple testing.
Results
Twelve participants (8 Female; Age 66±8) with chronic CIPN due to treatment for various oncologic diagnoses were recruited, treated, and assessed post-treatment (100% compliance). Overall patient satisfaction was 82.4%, with dissatisfaction predominantly around the desire for a greater number of treatment sessions and reported difficulty in performing the home exercises. A stable baseline was demonstrated for VAS, TNAS, and TUG. Significant improvements in all measures (trend for TNAS) were found between pre and post-treatment. Maximal pain intensity (VAS-week max) median was 74.6 at baseline and decreased by 27.5 (CI -37.5, 20.0; p=0.02), and average pain (VAS-week average) was 60.4 at baseline and decreased by 25.0 (CI 30.0, 10.0; p=0.01). Sensory symptoms and pain, as assessed by TNAS, were 58.3 (out of a maximal 90) and decreased by 13.0 (CI -26.5, -1.5; p=0.06). Mobility median, as assessed by TUG was 14.0 seconds and decreased by 4.7 seconds (CI – 7.7, 3.3; p=0.01).
Conclusions
Explicit sensory retraining appears to be a feasible and effective physical therapy treatment for pain and sensory loss of the lower extremities and their functional consequences for individuals with CIPN. The rationale of sensory system-specific treatment seems relevant. Significant improvement in pain intensity, sensory function, mobility and balance, in addition to high participants’ satisfaction and their demand for additional treatment sessions, call for further investigation of this therapeutic tool in this population.
References
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Presenting Author
Hadas Ofek
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Neuropathic Pain - Peripheral