Wireless Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Chemotherapy-Induced Peripheral Neuropathy (CIPN): A Proof-of-Concept Randomized Clinical Trial

• Published in: The journal of pain Vol. 25; no. 5; p. 104431
• Main Authors: Gewandter, Jennifer S., Culakova, Eva, Davis, Jenae N., Gada, Umang, Guido, Joseph J., Bearden, James D., Burnette, Brain, Shah, Dhaval, Morrow, Gary R., Mustian, Karen, Sluka, Kathleen A., Mohile, Nimish
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2024
• Subjects: Adult; Aged; Antineoplastic Agents - adverse effects; Chemotherapy-induced peripheral neuropathy; Feasibility Studies; Female; Humans; Male; Middle Aged; Peripheral Nervous System Diseases - chemically induced; Peripheral Nervous System Diseases - therapy; Proof of Concept Study; Randomized clinical trial; Transcutaneous Electric Nerve Stimulation - instrumentation; Transcutaneous Electric Nerve Stimulation - methods; Transcutaneous electrical nerve stimulation; Wearable Electronic Devices; Transcutaneous electrical nerve stimulation; Chemotherapy-induced peripheral neuropathy; Randomized clinical trial
• DOI: 10.1016/j.jpain.2023.11.014
• ISSN: 1526-5900; 1528-8447

Chemotherapy-induced peripheral neuropathy (CIPN) affects approximately 30 to 60% of people who receive neurotoxic chemotherapy. CIPN is associated with impaired quality of life and function and has few effective treatments. This 6-site, subject and assessor-blinded randomized clinical trial (RCT) was designed to assess 1) preliminary efficacy (ie, alpha pre-specified at .2) of a wearable, app-controlled, transcutaneous electrical nerve stimulation (TENS) device for chronic CIPN and 2) feasibility of conducting a confirmatory trial within the National Cancer Institute Community Oncology Research Program (NCORP) (NCT 04367480). The primary outcome was the EORTC-CIPN20. The main secondary outcomes were individual symptoms assessed daily (via 0–10 numeric rating scales). The primary analysis was an analysis of covariance (outcome: EORTC-CIPN20, fixed effect: arm, covariates: baseline EORTC-CIPN20 and site). Secondary analyses used a similar analysis of covariance models (excluding site) for each symptom on subgroups of subjects with ≥4 out of 10 for that symptom at baseline. 142 eligible subjects were randomized and received a device; 130 (91%) completed the study. The difference between groups in the EORCT-CIPN20 at the endpoint (placebo-active) was 1.05 (95% Confidence Interval: −.56, 2.67; P = .199). The difference between groups for the individual symptoms was as follows: hot/burning pain: 1.37 (−.33, 3.08; P = .112), sharp/shooting pain: 1.21 (−.37, 2.79; P = .128), cramping: 1.35 (−.32, 3.02; P = .110), tingling: .23 (−.61, 1.08; P = .587), numbness: .27 (−.51, 1.05; P = .492). An RCT of an app-controlled TENS device for chronic CIPN with excellent retention is feasible in the NCORP. Preliminary efficacy evidence suggests that TENS is promising for pain and cramping from CIPN. A confirmatory RCT of TENS for painful CIPN is highly warranted. Daily, home-based TENS therapy demonstrates promising efficacy for painful CIPN symptoms in this proof-of-concept randomized clinical trial. Future confirmatory trial is warranted. •This trial provides evidence for the preliminary efficacy of TENS for painful CIPN symptoms.•This trial demonstrates feasibility of conducting a confirmatory RCT of TENS for painful CIPN.•No effect of TENS on numbness or tingling associated with CIPN was observed.