Effectiveness of non-pharmacological interventions for chemotherapy-induced peripheral neuropathy-related pain: A systematic review and network meta-analysis.

PURPOSE: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, distressing, adverse effect of neurotoxic chemotherapy that can persist post-treatment, and may affect therapy and daily functioning. Pharmacological options remain limited; therefore, non-pharmacological strategies are increasingly used. However, their comparative effectiveness remains unclear. We aimed to compare and rank the effectiveness of non-pharmacological interventions for CIPN-related pain.

METHOD: We conducted a systematic review and frequentist network meta-analysis (NMA) of randomised controlled trials (RCTs). PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL databases were searched through 23, May 2025. Interventions were grouped as acupuncture-based, electrical stimulation-based, exercise-based, psychological, cryotherapy, or control. Pairwise meta-analyses and random-effects NMA were performed. Treatments were ranked using P-scores. The risk of bias was assessed independently by reviewer pairs using RoB 2.0.

RESULTS

Thirty-two RCTs (n = 1612) met the inclusion criteria, and 19 were used for NMA. Acupuncture-based interventions significantly reduced pain versus controls (standardised mean difference 0.66; 95% confidence interval 0.16-1.17). Treatment ranking based on P-scores suggested that cryotherapy ranked highest (P-score = 0.86), followed by exercise-based (P-score = 0.68), acupuncture-based (P-score = 0.54), and electrical stimulation-based (P-score = 0.42) interventions. No other intervention demonstrated a statistically significant reduction in pain compared with control conditions. Substantial heterogeneity was observed (τ2 = 0.54, I2 = 83.8%).

CONCLUSIONS

The effectiveness of cryotherapy and exercise remains unclear. However, our findings suggest that there is significant evidence to consider acupuncture as a supportive option for managing CIPN-related pain. Future well-powered RCTs are needed to support implementation in multidisciplinary oncology.