The Role of Transcranial Magnetic Stimulation and Peripheral Magnetic Field Therapy in Chemotherapy-Induced Peripheral Neuropathy: A Narrative Review

TL;DR

This review explores how magnetic stimulation therapies may help relieve pain from chemotherapy-induced neuropathy with fewer side effects than current treatments.

Contribution

The paper evaluates the emerging evidence for transcranial and peripheral magnetic stimulation as novel, low-risk treatments for CIPN.

Findings

Magnetic stimulation shows promise for pain relief in CIPN with few adverse effects.

Preliminary trials report improved nerve conduction and patient-reported outcomes.

Potential benefits include opioid reduction and mitigation of depression and anxiety.

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) often causes severe, persistent pain in patients undergoing chemotherapy. The current medication of choice, duloxetine, reduces pain in one out of every five patients treated. Opioids also provide partial relief but carry a risk of serious side effects. There is a need to develop effective treatments with fewer side effects. We review the results of trials for pain relief in CIPN, using magnetic fields to the brain or to the peripheral nerves in the limbs of patients. The initial results show benefit for pain relief, with few side effects.

Chemotherapy-induced peripheral neuropathy (CIPN) impairs quality of life and may result in discontinuation of anti-neoplastic therapy. In older patients, CIPN is associated with reduced executive function, more severe pain, comorbidities and polypharmacy. The use of magnetic fields to modulate central and peripheral neurons may offer some benefit for relieving neuropathic pain, with few adverse effects. The evidence of the benefits of using transcranial magnetic stimulation (TMS) or peripheral magnetic stimulation (PMS) in patients with CIPN is evaluated in this narrative review. Improved patient-reported outcomes and more rapid nerve conduction velocities in preliminary trials suggest efficacy in patients with CIPN. The potential for additional, broader applications in CIPN includes biomarkers of progression to chronic neuropathic pain, opioid-sparing benefits, and mitigating associated depression and anxiety. Because magnetic stimulation (MS) is relatively resource intense and time consuming, requiring multiple sessions of therapy, its availability is still limited, and multi-center trials are challenging. Further research with sham-controlled clinical trials, using standardized MS techniques and outcome assessments are needed.

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