Management of Compressive Neuropathy in Lymphoma Patients

Introduction to TENS Therapy

The American Society of Clinical Oncology recommends TENS as part of a multimodal pain management strategy for lymphoma patients with compressive neuropathy, with a weak strength of recommendation and low evidence quality 4
TENS should be considered only as part of a multimodal pain management strategy in lymphoma patients with compressive neuropathy, never as standalone therapy, and must be combined with definitive oncologic treatment, appropriate analgesics, and physical therapy 1, 2

TENS is most suitable for focal neuropathic pain rather than diffuse neuropathy 2
TENS is suitable as adjunctive therapy in patients already receiving duloxetine, which has moderate-level evidence for established chemotherapy-induced peripheral neuropathy 3, 2
The American College of Physicians may recommend TENS for patients who cannot tolerate or have contraindications to pharmacologic options, although specific guidelines are not provided 4

Initiate duloxetine as first-line pharmacologic treatment, and refer to physical therapy for movement-based interventions 3, 2, 4, 5
Ensure adequate systemic lymphoma treatment is ongoing 1

Approximately one-third of patients experience mild skin irritation at electrode sites 1, 6
TENS provides no benefit for acute or subacute pain, with insufficient evidence 1
The device works by providing non-painful electrical stimulation to cutaneous nerves to potentially block pain signals 2

Acupuncture has comparable or potentially superior evidence for cancer-related pain 7, 4
Scrambler therapy demonstrated better outcomes than TENS for chemotherapy-induced peripheral neuropathy 3, 2
Gabapentinoids or tricyclic antidepressants may be tried if duloxetine is insufficient, although evidence is limited 3, 2