lindblad2015

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DOI 10.1007/s00520-015-3060-7
ORIGINAL ARTICLE
Evaluation of the treatment of chronic
chemotherapy-induced peripheral neuropathy using long-wave
diathermy and interferential currents: a randomized controlled
trial
Katarina Lindblad 1 & Leif Bergkvist 2 & Ann-Christin Johansson 3
Received: 2 September 2015 / Accepted: 14 December 2015
# Springer-Verlag Berlin Heidelberg 2015
Abstract
Purpose The purpose was to investigate the effects of longwave diathermy in combination with interferential currents
(interferential therapy and long-wave diathermy at high power
(ITH)) in comparison with long-wave diathermy at a power
below the active treatment dose (long-wave diathermy at low
power (LDL), control group) on sensory and motor symptoms
in patients with chronic chemotherapy-induced peripheral
neuropathy (CIPN) in the lower extremities.
Methods Sixty-seven patients with chronic CIPN were randomized to 12 weeks of either ITH or LDL. Follow-up assessments were performed after the treatment period and at
37 weeks after randomization. The primary outcome was pain
(Numeric Rating Scale (NRS)), and the secondary outcomes
were discomfort, nerve symptoms, subjective measurement of
dizziness (Dizziness Handicap Inventory), and balance.
Differences within and between groups were analyzed.
Results Pain intensity decreased significantly only in the LDL
group directly after the treatment period from NRS median 25
to median 12.5 (P = 0.017). At the 37-week follow-up, no
changes were detected, irrespective of group (NRS 13 vs.
20, P = 0.885). Discomfort decreased significantly in both
groups at both 12 and 37 weeks after the baseline
(P < 0.05). Balance disability showed significant declines in
both groups at 12 and 37 weeks (P = 0.001/0.025 in the ITH
group vs P = 0.001/<0.001 in the LDL group). Balance ability
(tightened Romberg test) increased significantly at both 12
and 37 weeks in both groups (P = 0.004/<0.040 in the ITH
group) but did not improve in the LDL group at any of the
follow-up time points (P = 0.203 vs P = 0.383). The onelegged stance test was unchanged in the ITH group after
12 weeks but improved 37 weeks after baseline (P = 0.03).
No significant changes were observed in the LDL group at
any of the follow-up time points.
Conclusion This study provides no support for the use of a
combination of long-wave diathermy and ITH as a treatment
option for patients with chronic CIPN. However, the chronic
CIPN symptoms decreased with time irrespective of the
treatment.
Keywords Physical therapy . Electrotherapy . Diathermy .
Interferential current . Cancer
Introduction
* Katarina Lindblad
[email protected]
1
Department of Surgery, Västmanland County Hospital, 721
89 Västerås, Sweden
2
Department of Surgery, Centre for Clinical Research, Uppsala
University, Västmanland County Hospital, 721 89 Västerås, Sweden
3
Department of Physiotherapy, School of Health, Care and Social
Welfare, Centre for Clinical Research, Mälardalen University,
Västmanland County Hospital, Box 883, 721 89 Västerås, Sweden
The use of chemotherapy has led to prolonged remission and
survival in numerous human cancer diseases. The progress
and development of chemotherapeutic agents has, however,
come at the cost of toxicity, which may lead to long-lasting
negative side effects.
The nervous system, both centrally and peripherally, has
turned out to be especially sensitive to these agents.
Chemotherapy-induced peripheral neuropathy (CIPN) is common and includes sensory deficit, pain, loss of motor functions, and impaired proprioception, which in turn may affect
balance and fine motor skills [1, 2]. It is mainly localized to
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the peripheral parts of the extremities and may be transient or
permanent [3] and thus affecting the quality of life and functional capacity of the patients [4].
CIPN is a common, potentially severe, and often doselimiting side effect of exposure to numerous classes of antineoplastic agents, including platins, taxanes, vinca alkaloids,
bortezomib, and thalidomide [5].
The incidence of CIPN varies according to the agents used
but increases when patients receive a mixture of several chemotherapeutic agents and when they have concurrent comorbidities with the neuropathies, e.g., diabetes [2, 6]. Currently,
no evidence-based treatment is available for acute or chronic
CIPN. A variety of different drugs or drug combinations have
been clinically tested, but the value of these treatments remains uncertain [7]. Although some promising results have
been reported regarding the effects of nutraceuticals in the
prevention or treatment of CIPN (magnesium, calcium, vitamins E and B6, glutamine, glutathione, N-acetyl cysteine,
omega-3 fatty acids, acetyl-L-carnitine, and alpha lipoic acid),
additional research is needed to evaluate the effect of these
treatments [8].
Many patients with chronic CIPN are referred to physical
therapy, which is based more on clinical experience and tradition than on scientific evidence.
Acupuncture and electrical sensory stimulation have also
been evaluated, but only in studies with small samples and
without convincing treatment effects [9, 10].
In a nonrandomized study without a control group performed by Smith et al., sensory electrical stimulation was
tested [11]. The intensity of the treatment was gradually
increased over 10 days. A 20 % reduction of pain was detected in 15 out of the 16 participating patients. However,
the pain gradually returned to pretreatment levels 1 or
2 months after the treatment period. Another nonrandomized
study that used Scrambler therapy, which minimizes pain
signals via cutaneous nerve block, reported reduced pain
and an increase in the quality of life of participants [12].
Significant changes in pain from the baseline were observed
at 14, 30, 60, and 90 days after the baseline measures and
treatment. Likewise, Pachman et al. showed decreased pain,
tingling, and numbness after ten daily treatment sessions of
Scrambler therapy on patients with chronic CIPN [13]. Our
clinical experience indicates that treatment with long-wave
diathermy may decrease chronic CIPN symptoms, as pain is
assumed to be reduced by electromagnetic radiation, which
increases circulation and heat according to the capacitor
method [14].
Interferential therapy is an electrophysical method that is
based on the application of an electric field in the painful area
via four electrodes or vacuum cups that are placed on the skin.
Increased blood circulation and pain relief are supposed to be
achieved [15]. Interferential therapy uses two different intermediate frequencies (1001–10,000 Hz) of alternating currents
in the painful area. The two medium-frequency currents come
together, thereby creating a stream with a lower frequency (1–
1000 Hz) or beats per second (bps). The treatment effect corresponds to the gate control theory: the inhibition of pain
signals in small-diameter fibers by activity in large-diameter
Aβ fibers by spinal neurons [16].
Some studies have reported the reduction of pain by interferential currents after pain was experimentally induced or
induced by cold in otherwise pain-free volunteers compared
with a control or placebo [17–19]. However, research on the
effect of electrical inhibition on chronic CIPN is limited, even
if this approach is used in clinical practice for reducing chronic
CIPN.
The aim of this study was to investigate the effects of combination therapy with long-wave diathermy at high-power and
interferential currents compared with long-wave diathermy at
low power (control group) on sensory and motor symptoms in
patients with chronic CIPN in the feet and lower legs. Sensory
and motor symptoms were defined as pain, discomfort, numbness, and balance impairment.
Method
Study design
This was a randomized controlled trial with assessment performed before randomization and 12 and 37 weeks after the
baseline measurements. The study protocol was registered in
Clinical Trials Gov, reference number NCT02088996.
Study population
The participants had chronic CIPN symptoms after chemotherapy treatment, as assessed by their responsible physician.
The patients were recruited consecutively from the
Västmanland County Hospital, Västerås, Sweden, from
January 2010 to February 2014; they were all referred to
the physical therapy department by the consulting physician.
The inclusion criteria were as follows: patients aged over
18 years who received chemotherapy and had documented
side effects, such as numbness, tingling, pain, or a swelling
sensation in the feet/lower legs. The exclusion criteria were
pregnancy, thrombosis, thrombophlebitis in the feet or lower
legs, muscle cramps, acute bleeding disorders, dementia,
type 1 diabetes mellitus, open sores on the feet or lower
legs, peripheral sensory neuropathies caused by factors other
than chemotherapy, and ongoing chemotherapy with drugs
known to cause chronic CIPN.
An independent physical therapist interviewed potential
participants to check for eligibility. Patients who met the
study criteria were informed about the study and asked to
participate in it.
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The patients who gave their approval for participation were
randomized into one of the two study groups:
&
&
Interferential therapy and long-wave diathermy at high
power (ITH)
Long-wave diathermy at low power (LDL)
The patients were informed that they would be randomized
into one of the groups: ITH or LDL. The LDL treatment was
chosen as a placebo.
Sixty-seven participants entered the trial; 59 were followed
up after 12 weeks and 50 patients were followed up after
37 weeks (Fig. 1).
There were no significant differences between groups before treatment (at the baseline) (Table 1).
Treatment
Both groups were treated by a physical therapist once a week
for 12 weeks. Treatment manuals were prepared beforehand,
and treatments were administered according to these manuals.
Treatment was considered complete in both groups if it had
been administered at least nine of the 12 planned occasions
(75 %).
distally and dorsally on the patient’s leg. An electrode gel was
applied to the sole of the patient’s foot. Treatment was delivered via application of circular motions and light pressure of
the active electrode to the sole of the foot for 6 min (Fig. 2).
The treatment manual is available [20].
Interferential therapy was performed on the lower legs with
the patient placed in a supine position. Treatment was administered using an Electro Stimulation Device ES 520 &
Vacuum Unit for 15 min/lower leg. Four vacuum electrodes
were placed on the lower leg, with a channel intersecting the
other. The electrodes were placed medially and laterally
(Fig. 3). Wet electrode sponges were placed in the vacuum
electrodes. A frequency of 0–100 Hz was used, which provides both sensory and motor nerve stimulation. When the
stimulation began, the patients were asked to indicate when
the stimulation felt strong but did not hurt. The treatment
manual is available [21].
The long-wave diathermy at low power group (control group)
The control group was treated with only LDL in the low-effect
range, which was applied to the soles of the feet using a
Skanlab 25 Body Wave® apparatus for 6 min. This low effect
was not expected to have any therapeutic effect. The treatment
manual is available [20].
The interferential therapy and long-wave diathermy at high
power group
Measurements
This treatment group received ITH. Long-wave diathermy
was administered at the soles of the feet using a Skanlab 25
Body Wave® apparatus. A ground electrode rod was placed
All measurements were performed on both groups at the baseline and at 12 and 37 weeks after the baseline by an independent physical therapist who was not involved in the treatment.
Fig. 1 Flowchart
Assessed for eligibility
(n = 73)
Excluded (n = 2)
declined participation (n = 1)
Randomized
(n = 70)
Interferential therapy and
long-wave diathermy at
high power (n = 34)
Did not meet the inclusion
criteria (n = 3)
Long-wave diathermy
at low power (n = 33)
Withdrew from planned
treatment/died (n=3)
Withdrew from planned
treatment/died (n=5)
Follow-up 12 weeks after
treatment (n = 29)
Withdrew from planned
follow-up (n=3 ) or
died (n=2)
Follow-up 12 weeks after
treatment (n = 30)
Withdrew from planned
follow-up (n=4 )
Follow-up 37 weeks
after treatment (n=24 )
Follow-up 37 weeks after
treatment (n=26 )
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Table 1 Baseline demographics, including name, age, sex, diagnosis,
and information of chemotherapy
ITH group
n = 34
LDL group
n = 33
Sex, women/men
17/17
17/16
Age, mean (SD) (years)
62.77
(±12.1)
65.26
(±9.0)
Diagnosis, frequency
Uterine cancer
2
1
Pancreatic cancer
Gastric cancer
0
1
1
0
Cervix cancer
2
1
Lymphoma
Colon cancer
0
17
4
12
Ovarian cancer
Breast cancer
2
1
2
1
Basalioma
1
0
Rectal cancer
Small-bowel cancer
7
1
10
1
25
4
23
5
1
1
3
0
3
1
0
1
11 (12.0)
12 (9.3)
11 (6.5)
11 (3.9)
Chemotherapeutic agent, frequency
Oxaliplatin
Taxanes (paclitaxel, docetaxel,
paclitaxel/carboplatin)
Vincristine
Capecitabine
Cisplatin
Vinblastine
Months between completed chemotherapy
and randomization, means (SD)
Number of chemotherapy cycles, means
(SD)
Pain intensity and discomfort
Numeric Rating Scale (NRS) was used for measuring the intensity of pain. This is a reliable instrument that has been
validated for patients with cancer [22, 23]. Patients rated their
pain from 0 to 100, with 0 reflecting no pain and 100 reflecting
the worst possible pain. Discomfort was defined as an uncomfortable feeling of not knowing where the feet are in relation to
the room; this was also assessed using an NRS in which 0
represented no discomfort and 100 represented the worst possible discomfort.
For the analysis of the nerve symptoms, the depictions of
legs with drawn symptoms were divided into ten zones, four
on the feet and six on the legs, by using a transparent template
with all ten zones marked out. The mean number of zones
marked with symptoms of numbness was then calculated for
each patient based on the sum of zones for both legs (Fig. 4).
This method was created by the researchers and has not been
tested for reliability and validity.
Balance disability/ability testing
Three tests were undertaken:
1. Measurement of a subjective experience of balance via the
Dizziness Handicap Inventory, for the assessment of patients’ experience of their balance [26]. The questionnaire
contains 25 items and has good reliability in vestibular
disorders/disabilities [27]. In this study, the form was abbreviated and contained only 15 questions: 10 questions
that were constructed for vertigo symptoms were omitted,
as they were considered inappropriate for this patient
group.
2. Tightened Romberg test (tandem standing with the
hands crossed and touching the shoulders, maximum
60 s) [28, 29].
3. One-legged stance test (standing on one leg with the hands
crossed and touching the shoulders, maximum 30 s) [28].
The tests (1 and 2) have good validity and reliability when
applied to healthy elderly females. In the tightened Romberg
test and one-legged stance test, the patient was allowed three
attempts of each test, and the best result was recorded. The
tests were performed with closed eyes. The timer was stopped
when the patient moved the feet/arm position and/or looked
when the eyes should be closed.
The means of both legs regarding both the tightened
Romberg test and the one-legged stance test were calculated
for each patient, and this value was used for all descriptions
and analyses.
Other measures
Baseline demographics, including name, age, sex, diagnosis,
and chemotherapeutic agent, were also recorded.
Data analyses
Nerve symptoms
The definition of nerve symptoms included sensations of pins
and needles, tingling, and paresthesias. Patients were asked to
draw the occurrence of any of the nerve symptoms of their
legs and feet on a sketch, which was based on a pain-drawing
sketch [24, 25].
As there are few available studies in this field, we performed a
post hoc power analysis based on data from the first 26 patients included in the study.
We estimated that the clinically significant difference in
pain intensity between the treatment groups was 17 (SD, 22)
units of the NRS, with a power of 80 % and an alpha of 0.05.
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Fig. 2 The Skanlab 25 Body
Wave® device positioned to treat
chronic CIPN
This estimation required 31 participants in each group.
Regarding the Dizziness Handicap Inventory, we estimated
that a clinically significant difference between groups
corresponded to a difference of 6 units (SD, 7), which required
28 patients in each group, with a power of 80 % and an alpha
of 0.05. Based on our experience from the first 26 patients
included in the study, the dropout rate was 15 %; thus, we
decided to include 70 patients in the current study.
Comparisons between groups were performed according to
the intention to treat principle, using the Mann–Whitney U
test for ordinal data and the chi-squared test for nominal data,
Fig. 3 The Electro Stimulation
Device ES 520 & Vacuum Unit
device positioned to treat chronic
CIPN
and differences within groups were analyzed using the
Wilcoxon test.
Differences regarding the mean of zones with numbness before and after treatment were calculated for each
patient and compared between groups using the chisquared test.
Because not all patients had pain at the baseline, we performed an adjustment for pain at the baseline using linear
regression analyses. In these analyses, the dependent variables
were pain intensity at 12 and 37 weeks, and pain at the baseline and group was independent variables.
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Thirty-seven weeks after the baseline, the medians for pain
had decreased to 12.5 in the ITH group, but increased to 20
in the LDL group; however, none of these changes was significant (P = 0.173 in the ITH group and 0.146 in the LDL
group) (Table 2).
Discomfort decreased significantly in both groups at both
12 and 37 weeks after the baseline (P < 0.05) (Table 2).
Nerve symptoms
All patients reported numbness prior to treatment. The median
number of affected zones in the ITH group was 5.5 at the
baseline, and it significantly decreased to four zones 12 weeks
after the baseline (P = 0.003). Similarly, the number of numbness zones decreased in the LDL group from five to four
(P = 0.002). Both of these improvements remained after
37 weeks (Table 2).
Balance disability/ability
Fig. 4 Sketch of numbness
Significance was set at P ≤ 0.05. Collected data were processed using the Statistical Packages for the Social Sciences
(SPSS), version 22.
The study was approved by the Research Committee of
Uppsala University, no. 2010/364, 2011-02-28.
Results
Comparison of differences between groups
Changes in outcome variables were not significantly different
between the two groups at any of the follow-up time points
(Table 2).
After an adjustment for baseline values of the primary outcome, variable pain intensity, the analyses showed that baseline pain values had no significant effect on the results (slope
coefficient, −0.242; P = 0.957 (pain intensity at 12 weeks) and
slope coefficient, 2.873; P = 0.613 (pain intensity at
37 weeks)).
Both the ITH group and the LDL group showed significant
declines in balance disability between before and after the test.
The median value of the DHI decreased from 14 at the baseline to 8 after 12 and 37 weeks in the ITH group (P = 0.001
and 0.025, respectively). The corresponding values in the
LDL group were 14 at the baseline, with a decrease to 9
(P = 0.001) 12 weeks after the baseline and 10 (P < 0.001)
37 weeks after the baseline.
In the tightened Romberg test, the mean value at the baseline for both the right and left legs in both groups was 9 s. In
the ITH group, there was a significant (P = 0.004) improvement at 12 weeks after the baseline, to 11 s, and a further
significant (P = 0.040) improvement to 13 s at 37 weeks after
the baseline. Balance did not improve in the LDL group at any
of the follow-up time points (P = 0.203, 12 weeks after the
baseline and P = 0.383, 37 weeks after the baseline).
The results of the one-legged stance test were unchanged in
the ITH group 12 weeks after the baseline but improved significantly from 5 to 7 s 37 weeks after the baseline (P = 0.03).
No significant change in the one-legged stance test was observed in the LDL group at any of the follow-up time points
(Table 2).
Comparison within groups
Pain intensity and discomfort
Discussion
Pain intensity was 30 (median) in the ITH group at the baseline and 25 in the LDL group; nine patients in the ITH group
and 13 patients in the LDL group rated pain as 0 at the baseline. Twelve weeks after the baseline, pain had decreased to 20
in the ITH group and to 12.5 in the LDL group. The results of
these analyses were significant only in the LDL group
(P = 0.55 in the ITH group and 0.017 in the LDL group).
The aim of this study was to compare the effect of combination therapy (long-wave diathermy at high-power and interferential currents) with LDL (control group) for sensory
and motor symptoms in patients with chronic CIPN in the
feet and lower legs. Our results showed some improvement
in both treatment groups over time, although no significant
differences were detected between groups. The chronic
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Table 2
Medians, means, and dispersion values at the baseline and at 12 and 37 weeks
Baseline
Pain intensity (NRS 0–100),
median (q1–q3)
Numbness zone frequency
(0–10), median (min–max)
Discomfort (NRS 0–100),
median (q1–q3)
DHI (0–60), median (q1–q3)
Tightened Romberg test, eyes
closed, both legs (0–60 s),
mean (SD)
One-legged stance, eyes closed,
both legs (0–30 s), mean (SD)
After 12 weeks
After 37 weeks
ITH
LDL
ITH
LDL
P valuea
ITH
LDL
P value
30 (0–50)
25 (0–58)
20 (0–40)
13* (0–43)
0.804
13 (0–47)
20 (0–40)
0.885
6 (1–10)
5 (2–10)
4** (0–8)
4** (2–8)
0.938
4*** (0–7)
4*** (0–7)
0.828
60 (34–80)
70 (35–80)
40*** (23–53)
53** (30–70)
0.503
38* (20–54)
50* (30–75)
0.816
14 (8–34)
9 (12.2)
14 (11–22)
9 (10.8)
8*** (1–20)
11* (11.1)
9*** (4–16)
12 (15.4)
0.489
0.241
8* (4–22)
13* (15.9)
10*** (6–16)
8 (6.09)
0.922
0.297
5 (5.2)
4 (4.2)
5 (4.7)
4 (2.7)
0.994
7* (6.6)
5 (83.5)
0.784
ITH interferential therapy and long-wave diathermy at high power, LDL long-wave diathermy at low power
a
The P values represent the comparison of differences in changes within each group from the baseline to 12 and 37 weeks after the baseline, respectively
*P ≤ 0.05, **P ≤ 0.01, ***P ≤ 0.001
CIPN symptoms decreased with time irrespective of treatment which might be an effect of the natural history of
chronic CIPN. According to Pachman and coworkers, the
CIPN symptoms decrease with time, but for some patients,
the symptoms are persistent [30]. It cannot be ruled out that
the improvement that the patient experienced was an effect
of the natural course.
These results are in contrast with the clinical impression of
the treatment response reported for selected patients.
However, these were probably influenced by the fact that the
symptoms are troublesome and influence daily life and that
the patients value and appreciate every effort made to decrease
their symptoms. This highlights the need for randomized studies aimed at evaluating treatment effects over time to disentangle the true treatment effects from the natural course of the
disease.
We cannot be absolutely sure that the treatment that was
administered to the control group was without effect; however, this treatment was far below the intensity that is believed to
have a therapeutic effect. If we had left the control group
without any treatment at all, the difference in the attention
provided to the groups would have represented a problematic
bias. The possible placebo effect from receiving treatment was
assumed to be equal in both groups since both groups got
similar treatment attention. In this study, we chose to administer a combination of treatments to the treatment group, i.e.,
interferential currents and long-wave diathermy at high power,
because the idea was that both methods, given at the recommended treatment dosage, stimulate the nerves and complement each other.
The theoretical background for our treatment was
based on the gate control theory [31]. Acupuncture is, at
least in part, a parallel treatment mechanism that has also
been evaluated on this patient group by Rostock et al.
[32]. Their study included four relatively small treatment
groups (14–17 participants), and in agreement with our
results, these researchers did not find any significant differences between treatments. In the study reported by
Coyne et al. [12], the effect of Scrambler therapy was
evaluated in patients with chronic CIPN. Those authors
showed that the pain was significantly reduced after 10,
30, 60, and 90 days. The same pattern was seen in the
nonrandomized study on chronic CIPN patients by
Pachman et al.; these authors, however, demanded
placebo-controlled studies [13].
In a study performed by Smith et al. [11], the pain
reoccurred in most of the patients 1 to 2 months after the
administration of treatment with electrostimulation.
However, none of these studies included a control group,
which renders it difficult to draw any conclusions regarding
the treatment. In our study, the LDL group exhibited significantly reduced pain at 12 weeks; however, at 37 weeks, the
pain had reoccurred, which was similar to the pattern reported
by Smith et al.
The present study had some strength in that the physical therapist that performed all the measurements and
tests was independent. Further, the study comprised
follow-up sessions, both directly after the treatment and
a long-term follow-up. The study also had some limitations. First, 25 % of the 67 patients who received treatment were not followed up. This can be explained by the
vulnerability of this patient group and the generally weak
health condition of several patients. Unfortunately, ten
patients died during the follow-up period (Fig. 1).
Second, we could not report the patients’ chemotherapy
dosages; unfortunately, doses are written on separate dose
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charts for logistic reasons and kept in a separate department in our hospital. Presentation of dosage might, however, have added valuable information. Third, the sketches
used for describing the nerve symptoms have not been
psychometrically evaluated. This method was developed
by our research group, as we did not find any established
method in Swedish for describing the distribution of
chronic CIPN symptoms. Similarly, the validity of the
Dizziness Handicap Inventory can be questioned, because
several items were omitted and it had not been psychometrically tested on this patient group. Generally, it is
difficult to find sensible and clinical applicable measurement methods for the nerve symptoms and functional limitations of these patients. The FACT/GOG-NTX which
has the advantage of being validated in Swedish could
have been considered [33], but many items in this questionnaire do not capture entities which correspond to our
aim. In general, there is a need for valid and reliable
measurement methods in Swedish, for capturing the functional limitations of patients with chronic CIPN symptoms. As pain intensity was the primary outcome variable,
the study sample was underpowered in relation to pain.
According to our power calculation, we expected a difference of pain reduction of 17 points. This can be
questioned, since according to Farrar et al. [34], a clinically significant pain reduction of at least 30 % is
regarded as relevant. If we had chosen this benchmark,
the study sample could have been reduced. By including
67 patients, we increased power in relation to the second
outcome variable Dizziness Handicap Inventory.
The measurement of pain intensity does not seem to be the
ultimate method for capturing the symptoms of these patients.
The less specific concept of Bdiscomfort^ might better describe the chronic CIPN symptoms.
In conclusion, this study showed some improvement in
chronic CIPN symptoms 3 and 6 months after treatment by
chemotherapy. However, this improvement occurred irrespective of treatment by ITH. Considering costs and required treatment time in relation to treatment outcome, we cannot recommend long-wave diathermy in combination with interferential
currents as a treatment option in clinical practice for patients
with chronic CIPN.
References
Acknowledgments The study was supported by research grants from
the Västmanland County Hospital, Västerås, Sweden. We are grateful for
the support provided by physical therapists Jenny Ulmestedt and Karin
Tissier Knutsgård, for helping with the assessment and evaluation of the
patients. We also acknowledge Berit Werner-Erichsen, Head of Physical
Therapy, Surgical Department, Västmanland County Hospital, Västerås,
who gave permission for performing the study.
16.
18.
Compliance with ethical standards
19.
Conflict of interest The authors declare no conflicts of interest.
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