Precision acupuncture for chemotherapy-induced peripheral neuropathy: multitarget mechanisms and integrated clinical translation framework.

Chemotherapy-induced peripheral neuropathy (CIPN), a debilitating dose-limiting toxicity affecting 20-85% of cancer patients, lacks disease-modifying therapies. This review synthesizes evidence supporting acupuncture as a potential multi-target strategy against CIPN. Direct preclinical CIPN studies suggest that electroacupuncture (EA) may modulate selected neuroinflammatory and oxidative pathways, including TLR4/NF-κB signaling, TRPV1 upregulation, and spinal glial activation; proposed effects on Nav1.7-1.9, PGC-1α/AMPK, or HDAC6-related microtubule stabilization remain unconfirmed. Clinically, sham-controlled trials suggest that manual acupuncture and EA may alleviate pain, sensory symptoms, and quality-of-life impairment. High response rates for auricular acupuncture derive from an uncontrolled case series, and ALTENS findings are preliminary. The MC5-A Calmare device delivers Scrambler therapy and is distinct from ALTENS and acupuncture. Combination studies suggest possible additive benefit rather than established synergy. Safety profiles are generally favorable. However, clinical translation is impeded by methodological heterogeneity, subjective "De Qi" assessment, and inadequate patient stratification. Future research should focus on trials with lab markers and cost analyses to determine how well acupuncture helps people complete their treatment.