Treatment of Peripheral Neuropathy

Non-Pharmacological Interventions

The American Society of Clinical Oncology recommends duloxetine as a treatment option for chemotherapy-induced peripheral neuropathy, with a moderate strength of evidence 6
The American College of Clinical Oncology suggests that electrocutaneous nerve stimulation, including transcutaneous electrical nerve stimulation (TENS), may be considered for chemotherapy-induced peripheral neuropathy, although evidence is limited 1, 2
TENS works by providing non-pain electrical stimulation to cutaneous nerves to potentially block pain signals, and may be more appropriate for patients with focal peripheral neuropathic pain rather than diffuse neuropathy 3, 1
A comparative study showed that scrambler therapy was more effective than TENS for chemotherapy-induced peripheral neuropathy symptoms 2

The American Diabetes Association recommends first-line treatments for diabetic peripheral neuropathy, including tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs), and α-δ agonists (pregabalin or gabapentin), with treatment tailored based on comorbidities and contraindications 4
Combination therapy or addition of opioid agonists may be considered if pain control remains inadequate with first-line agents 4
Duloxetine is the only agent with a moderate recommendation for treatment of established chemotherapy-induced peripheral neuropathy 6, 8

The Mayo Clinic states that stem cell therapy for peripheral neuropathy remains largely investigational, with insufficient evidence from high-quality clinical trials to support its routine use 5, 4
None of the major clinical practice guidelines for neuropathic pain management recommend stem cell therapy as a standard treatment option 5, 4, 6
Stem cell therapy should only be considered within the context of clinical trials until more evidence is available 5, 4

A practical approach to management involves identifying and treating underlying causes, beginning with first-line agents based on neuropathy type and patient characteristics, and progressing to second-line treatments if inadequate response 4
Non-pharmacological approaches like TENS may be considered for focal neuropathic pain or as adjunctive therapy 1
Third-line treatments should be reserved for refractory cases, and stem cell therapy should only be considered within the context of clinical trials until more evidence is available 5, 4