---
title: "Chemotherapy-induced neuropathy"
url: "https://acuiq.com/wiki/evidence/chemotherapy-induced-neuropathy"
updated: 2026-10-10
last_verified: 2026-10-10
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-10"
reading_minutes: 8
sources: 15
---

# Chemotherapy-induced neuropathy

_What three systematic reviews, an umbrella review, trials of acupuncture and electroacupuncture for treating and preventing nerve damage from chemotherapy, and three guidelines from 2020 and 2022 report._

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](https://doi.org/10.1200/jco.22.01357) 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](/wiki/techniques/electroacupuncture).

## Reviews

The nearest Cochrane review is [Acupuncture for neuropathic pain in adults](https://doi.org/10.1002/14651858.cd012057.pub2) (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.

| Review | Trials and people | Comparisons | Main pooled result | Certainty |
| --- | --- | --- | --- | --- |
| [Shi 2023](https://doi.org/10.1007/s00432-023-05369-8), umbrella review of earlier reviews | 9 reviews covering 28 trials | Pooled across controls | Better pain, quality of life and nerve conduction scores | Methodological and evidence quality of all 9 reviews judged unsatisfactory |
| [Zhao 2025](https://doi.org/10.1007/s11764-025-01869-3), searched to October 2024 | 18 trials, 1,048 people | Usual care, drugs, vitamins and sham, pooled | Symptom improvement RR 1.11; pain SMD 0.93 lower | Not stated in the abstract |
| [Pan 2026](https://doi.org/10.2147/jpr.s631984), searched to January 2026 | 40 trials, 2,496 people | No treatment, drugs, a waiting list, exercise and sham, pooled | FACT-Ntx 1.43 points better; effective rate RR 1.74; no difference in worst pain | Very low (GRADE) |

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`](/points/LI04) (Hegu) and [`ST36`](/points/ST36) (Zusanli), with points on the hands and feet such as Bafeng (EX-LE10).

## Trials in established neuropathy

A [2019 trial](https://doi.org/10.1177/1534735419836501) 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](https://doi.org/10.1634/theoncologist.2019-0489) 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](https://doi.org/10.1136/bmjspcare-2018-001542) 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](https://doi.org/10.1016/j.ejon.2022.102171) 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](https://doi.org/10.1001/jamanetworkopen.2020.0681) 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`](/points/PC06) (Neiguan), [`SI03`](/points/SI03) (Houxi), [`LV03`](/points/LV03) (Taichong), [`GB42`](/points/GB42) (Diwuhui) and [`ST40`](/points/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](/wiki/research/sham-acupuncture) covers why a sham is hard to make inert.

## Trials of prevention

A [2016 sham-controlled pilot trial](https://doi.org/10.1007/s10549-016-3759-2) 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](https://doi.org/10.1093/oncolo/oyad065) 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](https://doi.org/10.1200/jco.20.01399) 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](https://doi.org/10.1016/j.annonc.2020.07.003) 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](https://doi.org/10.1200/jco.22.01357) 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](https://clinicaltrials.gov/study/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](/wiki/evidence/nausea-from-chemotherapy) and [Cancer-related fatigue](/wiki/evidence/cancer-related-fatigue).

AcuiQ’s [chemotherapy-induced peripheral neuropathy](/symptoms/neuropathy-peripheral-chemotherapy-induced) and [chemotherapy-induced neuropathy](/symptoms/chemotherapy-induced-neuropathy) pages list the protocols individual studies prescribed, each with its citation.

### Sources

1. Ju ZY, Wang K, Cui HS, et al., Acupuncture for neuropathic pain in adults, Cochrane Database of Systematic Reviews 2017 — https://doi.org/10.1002/14651858.cd012057.pub2
2. 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, Journal of Cancer Research and Clinical Oncology 2023 — https://doi.org/10.1007/s00432-023-05369-8
3. Zhao Y, Cao W, Zhang H, et al., The efficacy of acupuncture in the treatment of chemotherapy-induced peripheral neuropathy in cancer patients: a systematic review and meta-analysis, Journal of Cancer Survivorship 2025 — https://doi.org/10.1007/s11764-025-01869-3
4. Pan Z, Wu J, Xie Y, et al., Acupuncture for chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis with trial sequential analysis, Journal of Pain Research 2026 — https://doi.org/10.2147/jpr.s631984
5. Molassiotis A, Suen LKP, Cheng HL, et al., A randomized assessor-blinded wait-list-controlled trial to assess the effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy, Integrative Cancer Therapies 2019 — https://doi.org/10.1177/1534735419836501
6. Lu W, Giobbie-Hurder A, Freedman RA, et al., Acupuncture for chemotherapy-induced peripheral neuropathy in breast cancer survivors: a randomized controlled pilot trial, The Oncologist 2020 — https://doi.org/10.1634/theoncologist.2019-0489
7. D'Alessandro EG, Nebuloni Nagy DR, de Brito CMM, et al., Acupuncture for chemotherapy-induced peripheral neuropathy: a randomised controlled pilot study, BMJ Supportive & Palliative Care 2022 — https://doi.org/10.1136/bmjspcare-2018-001542
8. Stringer J, Ryder WD, Mackereth PA, Misra V, Wardley AM, A randomised, pragmatic clinical trial of ACUpuncture plus standard care versus standard care alone FOr Chemotherapy Induced peripheral Neuropathy (ACUFOCIN), European Journal of Oncology Nursing 2022 — https://doi.org/10.1016/j.ejon.2022.102171
9. Bao T, Patil S, Chen C, et al., Effect of acupuncture vs sham procedure on chemotherapy-induced peripheral neuropathy symptoms: a randomized clinical trial, JAMA Network Open 2020 — https://doi.org/10.1001/jamanetworkopen.2020.0681
10. Greenlee H, Crew KD, Capodice J, et al., 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 Research and Treatment 2016 — https://doi.org/10.1007/s10549-016-3759-2
11. Huang MC, Chang SC, Liao WL, et al., Acupuncture may help to prevent chemotherapy-induced peripheral neuropathy: a randomized, sham-controlled, single-blind study, The Oncologist 2023 — https://doi.org/10.1093/oncolo/oyad065
12. Loprinzi CL, Lacchetti C, Bleeker J, et al., Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO guideline update, Journal of Clinical Oncology 2020 — https://doi.org/10.1200/jco.20.01399
13. Jordan B, Margulies A, Cardoso F, et al., Systemic anticancer therapy-induced peripheral and central neurotoxicity: ESMO-EONS-EANO Clinical Practice Guidelines for diagnosis, prevention, treatment and follow-up, Annals of Oncology 2020 — https://doi.org/10.1016/j.annonc.2020.07.003
14. Mao JJ, Ismaila N, Bao T, et al., Integrative medicine for pain management in oncology: Society for Integrative Oncology-ASCO guideline, Journal of Clinical Oncology 2022 — https://doi.org/10.1200/jco.22.01357
15. ClinicalTrials.gov, NCT04917796: The effect of electroacupuncture on nerve pain caused by chemotherapy (chemotherapy-induced peripheral neuropathy) — https://clinicaltrials.gov/study/NCT04917796