Chemotherapy-induced neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is nerve damage from cancer drugs such as taxanes, platinum agents and vinca alkaloids, felt mostly as numbness, tingling and pain in the hands and feet. The 2022 SIO–ASCO pain guideline describes it as common, persistent and disabling, and notes that it raises the risk of falls. Trials of acupuncture ask two separate questions: whether it eases neuropathy that is already established, and whether needling during chemotherapy prevents it. Cochrane has not published a review of acupuncture for CIPN, so the reviews on this page come from other journals. Electroacupuncture, in which a small current is passed between needles, is described in Electroacupuncture.

Reviews

The nearest Cochrane review is Acupuncture for neuropathic pain in adults (Ju and colleagues, 2017), which covered nerve pain of any cause. It found 6 trials with 462 people, all at high risk of bias for blinding, and concluded that there was insufficient evidence to support or refute acupuncture for neuropathic pain in general or for any specific condition. Its abstract does not report a trial in chemotherapy-induced neuropathy. Reviews specific to CIPN followed. Many of their trials report an “effective rate”, the share of patients who improved by a set amount, such as one grade on a neuropathy scale.

RR is a risk ratio, so 1.74 means the effective rate was 74% higher in the acupuncture groups. SMD is a standardised mean difference, the gap between groups in units of the spread of scores. FACT-Ntx is a questionnaire on neuropathy symptoms. Shi and colleagues measured how far their 9 reviews drew on the same trials and classed the overlap as high. Pan and colleagues, at Guangzhou University of Chinese Medicine, found most of their 40 trials were run in China, and rated 10 at low risk of bias, 15 at some concerns and 15 at high risk. Their trials most often needled LI04 (Hegu) and ST36 (Zusanli), with points on the hands and feet such as Bafeng (EX-LE10).

Trials in established neuropathy

A 2019 trial by Molassiotis and colleagues at the Hong Kong Polytechnic University randomised 87 people who were having or had finished neurotoxic chemotherapy to acupuncture twice a week for 8 weeks or a waiting list with standard care. Assessors were blinded. At 8 weeks the acupuncture group had less pain on the Brief Pain Inventory and better neurological grading, quality of life and symptom distress, and some differences were still present at 14 and 20 weeks.

A 2020 pilot trial by Lu and colleagues at the Dana-Farber Cancer Institute in Boston randomised 40 women with neuropathy after taxane chemotherapy for breast cancer to 18 acupuncture sessions over 8 weeks or a waiting list. At 8 weeks the acupuncture group reported better sensory symptom, neurotoxicity and pain scores, and no serious side effects occurred. A pilot trial in São Paulo by D’Alessandro and colleagues, published in 2022, gave 33 people 10 sessions or no acupuncture; the acupuncture group improved on physical and functional quality-of-life scores, and the authors wrote that the clinical significance remained unclear.

The ACUFOCIN trial by Stringer and colleagues at the Christie NHS Foundation Trust in Manchester, published in 2022, randomised 120 people with grade II or worse neuropathy to a 10-week course of acupuncture with standard care or standard care alone. Of the 108 with primary outcome data, 36 of 53 in the acupuncture arm and 18 of 55 in the control arm improved by at least 2 points on their most troublesome symptom. Clinicians were blinded to allocation but participants were not, and none of the 16 events linked to acupuncture needed treatment.

None of those trials had a sham arm. A 2020 pilot trial in JAMA Network Open by Bao and colleagues at Memorial Sloan Kettering Cancer Center added one, a non-penetrating procedure away from acupuncture points, alongside usual care. It enrolled 75 people with persistent moderate to severe neuropathy who had completed at least 3 months of chemotherapy. Over 8 weeks the real acupuncture group had ear points and body points including LI04, PC06 (Neiguan), SI03 (Houxi), LV03 (Taichong), GB42 (Diwuhui) and ST40 (Fenglong), with 2 to 5 Hz current between LV03 and GB42. Pain on a 0 to 10 scale fell by 1.75 points with real acupuncture, 0.91 with sham and 0.19 with usual care. The statistical comparisons were made against usual care, and numbness fell by about the same amount with real and sham treatment. Sham acupuncture covers why a sham is hard to make inert.

Trials of prevention

A 2016 sham-controlled pilot trial by Greenlee and colleagues at Columbia University in New York gave 63 women with early breast cancer 12 weekly sessions of electroacupuncture or sham electroacupuncture during taxane chemotherapy; 48 completed the week 16 assessment. At week 12 worst-pain scores had risen in both groups with no difference between them. By week 16 the sham group had returned to baseline while the electroacupuncture group was still worsening, by 1.62 points more, and the authors suggested that future trials study treatment rather than prevention.

A 2023 sham-controlled trial by Huang and colleagues at China Medical University in Taichung, Taiwan, randomised 32 people with stage 3 colorectal cancer to real or sham acupuncture during chemotherapy and analysed 26. Patient-reported scores and sensory nerve conduction did not differ between the groups. Touch thresholds and motor nerve conduction declined from baseline with sham acupuncture but not with real acupuncture. In Pan’s 2026 review, prevention trials showed a higher effective rate with acupuncture, but no difference on FACT-Ntx scores.

What guidelines say

The 2020 ASCO guideline update on CIPN, led by Loprinzi, made no recommendation on acupuncture for either prevention or treatment, on low-quality evidence, and wrote that larger definitive studies were needed. It recommended duloxetine as the only drug with appropriate evidence for painful established CIPN. The 2020 ESMO–EONS–EANO guideline from the European Society for Medical Oncology states that the available evidence discourages acupuncture to prevent CIPN, citing the Greenlee trial, and that acupuncture might be considered in selected patients to treat symptoms, graded II, C. The 2022 SIO–ASCO guideline on integrative medicine for cancer pain, led by Mao, states that acupuncture may be offered for CIPN, a weak recommendation on low-quality evidence drawn from 2 reviews and 7 small trials. AcuiQ found no later edition of the ASCO or ESMO guideline when this page was checked in October 2026.

What the reviews could not settle

Most trials compared acupuncture with a waiting list, usual care or a drug, and patients reported their own symptoms knowing which group they were in. The one sham-controlled treatment trial in established neuropathy enrolled 75 people, and the reviews pooled sham with other comparators, so no review has an estimate against sham alone. Prevention rests on small trials whose results point in different directions. A phase III trial of electroacupuncture against sham, sponsored by Memorial Sloan Kettering (NCT04917796), enrolled 255 people and was active but not recruiting in July 2026, with no results posted; the SIO–ASCO guideline names it as the trial expected to clarify the question. Trials of acupuncture for other chemotherapy side effects are covered in Nausea from chemotherapy and Cancer-related fatigue.

AcuiQ’s chemotherapy-induced peripheral neuropathy and chemotherapy-induced neuropathy pages list the protocols individual studies prescribed, each with its citation.