This is the first case report on the use of acupuncture in treating multiple myeloma patients with BIPN. Our report suggests that acupuncture is a treatment option for patients experiencing BIPN. Fourteen acupuncture treatments helped the patient to have significant less neuropathic pain, reduced requirement for narcotics, and improved function with minimal side effects.
The acupuncture protocol was developed from our clinical experience and prior chemo-induced peripheral neuropathy acupuncture research [18
]. One randomized, blinded clinical trial showed the effectiveness of auricular acupuncture in treating cancer therapy induced neuropathy [18
]. The patients were randomized into one of three arms. One arm received real auricular acupuncture embedded at real ear acupuncture points, which is defined as points where the electrodermal signal is being detected. The other two arms were sham control arms: one received real auricular acupuncture at the placebo points and one received sham acupuncture through auricular seeds at the placebo points [18
]. All patients received two courses of real or sham auricular acupuncture in two consecutive months. The needles were left in place until they fell out or were removed at a followup appointment. Their pain intensity measured by VAS at the end of the second month was used to measure the treatment efficacy. This study showed that in the group that received real acupuncture, pain intensity decreased by 36% at the end of 2 months when compared with baseline, whereas it only decreased by 2% in the placebo groups (P
< .0001) [18
]. Moreover, a case series suggested potential efficacy of body acupuncture in treating patients with chemotherapy-induced peripheral neuropathy (CIPN) [19
]. Five patients with greater than world health organization grade II CIPN were treated with 6 weekly acupuncture treatments followed by 4 weeks of rest and 6 additional weekly acupuncture treatments. All patients but one finished all 12 acupuncture treatments. All five patients reported improvement in pain, tingling, and numbness. Pain scores decreased from 6–9/10 to 2–3/10 after acupuncture treatments. All patients had reduced analgesic medication intake. Four out of five patients reported persistent symptoms relief at the 6 month followup [19
We observed similar effect in our case report to those aforementioned reports, which is that patient with CIPN responded to acupuncture treatments. Our case suggests that acupuncture may be effective in relieving BIPN symptoms. Although studies have not been able to fully explain the mechanism of acupuncture, it has been proposed that acupuncture works through its effect on neurotransmitters and neurohormones [20
]. Animal research suggests that acupuncture accomplishes its anesthesia effect by stimulating nerves in the muscle, which then relay the signal to the spinal cord, midbrain, and hypothalamus-pituitary system, which then lead to the release of neurotransmitters and hormones, that is, endorphins and enkephalins [24
]. Other mechanisms such as activation of descending pain inhibiting pathways, deactivation of the limbic system, cortical cerebral vasodilation causing release of neuropeptide, and inhibition of the release of inflammatory factors have also been suggested to explain the effect of acupuncture analgesia [27
]. Recent study also showed that electroacupuncture alleviates bone cancer pain by suppressing spinal expression of interleukin-1β
in glia cells that are involved in the spinal transmission and processing of noxious inputs from the peripheral sites and facilitates pain [32
]. It is perceivable that acupuncture reduces BIPN symptoms by suppressing activities of glial cell and stimulating neurohormonal pathways, which increases endorphins release and reduces proinflammatory cytokines. Further study needs to be conducted to explore the role of acupuncture in helping patients suffering from BIPN and its mechanisms of action.
Our case report is limited in a couple of ways. First, the patient's relief of peripheral neuropathy symptoms may be due to a spontaneous remission rather than the effect of acupuncture. However, based on our clinical experience, once BIPN becomes so severe that it interferes with daily activities, it rarely resolves by itself, and even so, it usually takes a long time (months to years) to do so. Second, the clinical improvement in this patient was primarily documented by subjective end point, the VAS score. Changes in objective end points such as detailed neurological exam and nerve conduction study will help understand how acupuncture worked in reducing BIPN. This case report is the beginning of our endeavor to investigate the role of acupuncture in relieving BIPN. We plan to incorporate more objective measurements such as nerve conduction study into future studies on this topic.