Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common, dose-limiting effect of cancer therapy that often has negative implications on a patient’s quality of life. The pain associated with CIPN has long been recognized as one of the most difficult types of pain to treat. Historically, much effort has been made to explore pharmacological therapies aimed at reducing symptoms of CIPN. While many of these agents provide a modest relief in the symptoms of peripheral neuropathy, many have been shown to have additional negative side effects for cancer patients. Therefore, the authors suggest exercise rehabilitation as one lifestyle modification that may positively impact the lives of patients with CIPN. To our knowledge, there are currently no published clinical trials examining the role of exercise in preserving neurological function following chemotherapy. However, investigations using low-to-moderate intensity exercise as an intervention in patients with diabetic peripheral neuropathy and hereditary motor and sensory neuropathies have produced promising results. Given that cancer patients appear to tolerate exercise, it seems plausible that exercise rehabilitation could be used as an effective strategy to minimize CIPN-induced detriments to quality of life.
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References
American Cancer Society (2009) Cancer facts & figures 2009. Author, Atlanta, GA
National Heart, Lung, and Blood Institute (2008) NHLBI fact book, fiscal year 2007. Author, Bethesda, MD
National Cancer Institute (2009) Office of Cancer Survivorship. http://dccps.nci.nih.gov/ocs/researcher_factsheet.pdf. Retrieved 5 December 2009
Ganz PA (2007) Cancer survivorship: today and tomorrow. Springer, New York, pp 1–7
Lind J (1992) Tumor cell growth and cell kinetics. Semin Oncol Nurs 8(1):3–9
Rieger PT (2006) Cancer biology and implications for treatment. Clin J Oncol Nurs 10(4):457–460
Honea N, Brant J, Beck SL (2007) Treatment-related symptom clusters. Sem Oncol Nurs 23(2):142–151
Quasthoff S, Hartung HP (2002) Chemotherapy-induced peripheral neuropathy. J Neurol 249:9–17
Antonine JC, Camdessanche JP (2007) Peripheral nervous system involvement in patients with cancer. Lancet Neurol 6:75–86
Kaley TJ, DeAngelis LM (2009) Therapy of chemotherapy-induced peripheral neuropathy. Br J Haematol 145:3–14
Stubblefield MD, Burstein HJ, Burton AW, Custodio CM, Deng GE, Ho M et al. (2009) NCCN task force report: management of neuropathy in cancer. J NCCN 7:S-1-28
Woolf CJ (2004) Pain: moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med 140:441–445
Horowitz SH (2007) The diagnostic workup of patients with neuropathic pain. Med Clin N Am 91:21–30
National Health & Medical Research Council (1999) Acute pain management: scientific evidence. Commonwealth of Australia, Australia
Verstappen CP, Heimans JJ, Hoekman K, Postma TJ (2003) Neurotoxic complications of chemotherapy in patients with cancer: Clinical signs and optimal management. Drugs 63(15):1549–1563
Visovsky C (2003) Chemotherapy-induced peripheral neuropathy. Cancer Investig 21(3):439–451
Wolf CJ, Mannion RJ (1999) Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet 353:1959–1964
Reyes-Gibby CC, Marrow PK, Buzdar A, Shete S (2009) Chemotherapy-induced peripheral neuropathy as a predictor of neuropathic pain in breast cancer patients previously treated with paclitaxel. J Pain 10:1146–1150
Tulub AA, Stefanov VE (2001) Cisplatin stops tubulin assembly into microtubules. A new insight into the mechanisms of antitumor activity of platinum complexes. Int J Biol Macromol 28:191–198
Benoit E, Brienza S, Dubois JM (2006) Oxaliplatin, an anticancer agent that affects both Na+ and K+ channels in frog peripheral myelinated axons. Gen Physiol Biophys 25:263–276
Scadding JW, Kiltzenburg M (2006) Painful peripheral neuropathies. In: McMahon SB, Koltzenburg M (eds) Wall and Melzacks, textbook of pain, 5th edn. Elsevier Churchill Livingstone, Philadelphia, PA, pp 973–999
Jensen TS, Baron R (2003) Translation of symptoms and signs into mechanisms of neuropathic pain. Pain 102:13–18
Ahmad M, Goucke CR (2002) Management strategies for the treatment of neuropathic pain in the elderly. Drug Aging 19:929–945
Bakitas MA, Smith E, Cohen J, Fadul C (2004) Measurement issues in chemotherapy-induced peripheral neuropathy. In: Paper presented at the international conference on the mechanisms and treatment of neuropathic pain, Bermuda, November 4–6, 2004
Grothey A (2007) Oxaliplatin-safety profile: neurotoxicity. Semin Oncol 30(suppl 15):5–13
Tolle T, Zu Z, Sadosky AB (2006) Painful diabetic neuropathy: a cross-sectional survey of health state impairment and treatment patterns. J Diabetes Complications 20:26–33
Zelman D, Core M, Dukes E, Tai K, Brandenburg N (2005) Validation of a modified version of the brief pain inventory for painful diabetic peripheral neuropathy. J Pain Symptom Manage 29:401–410
Jensen MP, Hoffman AJ, Cardenas DD (2005) Chronic pain in individuals with spinal cord injury: a survey and longitudinal study. Spinal Cord 43:704–712
Bergbom-Engberg I, Grondahl G, Thibom K (1995) Patients’ experiences of herpes zoster and postherpetic neuralgia. J Adv Nurs 21:427–433
Galer B, Gianas A, Jensen M (2000) Painful diabetic polyneuropathy: epidemiology, pain, description, and quality of life. Diabetes Res Clin Pract 47:123–128
Tasmuth T, von Smitten K, Hietanen P et al (1995) Pain and other symptoms after different treatment modalities of breast cancer. Ann Oncol 6:453–459
Flier J, Van Muiswinkel FL, Jongenen CA et al (2002) The neuroprotective antioxidant alpha-lipoic acid induces detoxication enzymes in cultured astroglail cells. Free Radic Res 36:695–699
Bianchi G, Vitali G, Caraceni A et al (2005) Symptomatic and neurophysiological responses of paclitaxel- or cisplatin-induced peripheral neuropathy to oral acetyl-L-carnitine. Eur J Cancer 41:1746–1750
Tankova T, Cherninkova S, Koev D (2005) Treatment for diabetic mononeuropathy with alpha-lipoic acid. Int J Clin Pract 59:645–650
Eckel F, Schmelz R, Adelsberger H et al (2002) Prevention of oxaliplatin-induced neuropathy by carbamazepine. A pilot study. Dtsch Med Wochenchr 127:78–82
Sindrup S, Jensen T (1999) Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Pain 83:389–400
Goodman LS, Limbird LE, Milinoff PB et al (eds) (1996) Goodman and Gilman’s: the pharmacological basis of therapeutics, 9th edn. McGraw-Hill Professional, New York
Jensen TS (2002) Anticonvulsants in neuropathic pain. Eur J Pain 6(Suppl A):61–68
Backonja M, Beydoun A, Edwards KR et al (1978) Gabapentin for the symptomatic treatment of painful neuropathy. J Assoc Physicians India 26(5):403–406
Rao RD, Michalak JD, Sloan JA et al (2007) Efficacy of gabapentin in the management of chemotherapy-induced peripheral neuropathy. Cancer 110:2110–2118
Gatti G, Bonomi I, Jannuzzi G et al (2000) The new antiepileptic drugs: pharmacological and clinical aspects. Curr Pharm Des 6:839–860
Gwag BJ, Sessler FM, Robine V et al (1997) Endogenous glutamate levels regulate nerve growth factor mRNA expression in the rat denate gyrus. Mol Cells 7:425–430
De Santis S, Pace A, Bove L et al (2000) Patients treated with antitumor drugs displaying neurological deficits are characterized by a low circulating level of nerve growth factor. Clin Cancer Res 6:90–95
Bailey HH, Gipp JJ, Ripple M, Wilding G, Mulcahy RT (1992) Increase in gamma-glutamylcysteine synthetase activity and steady-state messenger RNA levels in melphalan-resistant DU-145 human prostate carcinoma cells expressing elevated glutathione levels. Cancer Res 52:5115–5118
Britten RA, Green JA, Warenius HM (1992) Cellular glutathione (GSH) and glutathione S-transferase (GST) activity in human ovarian tumor biopsies following exposure to alkylating agents. Int J Radiat Oncol Biol Phys 24:527–531
Joncourt F, Oberli-Schrammli AE, Stadler M et al (1995) Patterns of drug resistance parameters in adult leukemia. Leuk Lymph 17:101–109
Perry RR, Mazetta JA, Levin M, Barranco SC (1993) Glutathione levels and variability in breast tumors and normal tissue. Cancer 72:783–787
Redmond SM, Joncourt F, Buser K et al (1991) Assessment of P-glycoprotein, glutathione-based detoxidying enzymens and O6-alkylguanine-DNA alkyltransferase as potential indicators of constitutive drug resistance in human colorectal tumors. Cancer Res 51:2092–2097
Mulder TP, Manni JJ, Roelofs HM, Peters WH, Wiersma A (1995) Glutathione S-transferases and glutathione in human head and neck cancer. Carcinogenesis 16:619–624
Cook JA, Pass HI, Iype SN et al (1991) Cellular glutathione and thiol measurements from surgically resected human lung tumor and normal lung tissue. Cancer Res 51:4287–4294
Suzuki T, Nishio K, Tanabe S (2001) The MRP family and anticancer drug metabolism. Curr Drug Metab 2:367–377
Kawai H, Kiura K, Tabata M et al (2002) Characterization of non-small-cell lung cancer cell lines established before and after chemotherapy. Lung Cancer 35:305–314
Smyth JF, Bowman A, Parren T et al (1997) Glutathione reduces the toxicity and improves quality of life of women diagnosed with ovarian cancer treated with cisplatin: results of a double-blind, randomized trial. Ann Oncol 8:569–573
Cascinu S, Cordella L, Del Ferro E et al (1995) Neuroprotective effect of reduced glutathione on cisplatin-based chemotherapy in advanced gastric cancer: a randomized double-blind placebo-controlled trial. J Clin Oncol 13:26–32
Eisenberg E, Lurie Y, Braker C et al (2001) Lamotrigine reduces painful diabetic neuropathy: a randomized, controlled study. Neurology 57:505–509
Canavero S, Bonicalz V (1996) Lamotrigine control of central pain. Pain 68:179–181
Renno SI, Rao RD, Sloan J et al (2006) The efficacy of lamotrigine in the management of chemotherapy-induced peripheral neuropathy: a phase III randomized, double blind, placebo-controlled NCCTG trial, N01C3. J Clin Oncol 24(185):8530
Saudek CD, Werns S, Reidenberg MM (1977) Phenytoin in the treatment of diabetic symmetrical polyneuropathy. Clin Pharmacol Ther 22(2):196–199
Tremont-Lukats IW, Megeff C, Backonja MM (2000) Anticonvulsants for neuropathic pain syndromes: Mechanisms of action and place in therapy. Drugs 60:1029–1052
Wilson RH, Lehky T, Thomas RR et al (2002) Acute oxaliplatin-induced peripheral nerve hyperexcitability. J Clin Oncol 20:1767–1774
Traber MG (2006) Vitamin E. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins R (eds) Modern nutrition in health and disease, 10th edn. Lippincott Williams & Wilkins, Baltimore, pp 396–411
Argyriou AA, Chroni E, Koutras A et al (2005) Vitamin E for prophylaxis against chemotherapy-induced neuropathy: a randomized controlled trial. Neurology 64:26–31
Pace A, Savarese A, Picardo M et al (2003) Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 21:927–931
Jacobs EJ, Henion AK, Briggs PJ et al (2002) Vitamin C and vitamin E supplement use and bladder cancer mortality in a large cohort of US men and women. Am J Epidemiol 156:1002–1010
Moore DH, Donnelly J, McGuire WP et al (2003) Limited access trial using amifostine for protection against cisplatin- and three-hour paclitaxel-induced neuropathy: a phase II study of the Gynecologic Oncology Group. J Clin Oncol 21:4207–4213
Nelson DF, Gillespie BW, Diener MD et al (1984) Is misonidazole neurotoxicity altered by the use of phenytoin and/or dexamethasone in ROTG 79-18 and RTOG 79-16? Int J Radiat Oncol Biol Phys 10:1731–1734
Bergouignan FX, Vital C, Henry P et al (1988) Disulfiram neuropathy. J Neurol 235:382–383
Lehky TJ, Leonard GD, Wilson RH et al (2004) Oxaliplatin-induced neurotoxicity: acute hyperexcitability and chronic neuropathy. Muscle Nerve 29:387–392
Davis ID, Kiers L, MacGregor L et al (2005) A randomized, double-blinded, placebo-controlled phase II trial of recombinant human leukemia inhibitory factor (rhuLIF, emfilermin, AM424) to prevent chemotherapy-induced peripheral neuropathy. Clin Cancer Res 11:1890–1898
Hamers FP, van der Hoop RG, Steerenburg PA et al (1991) Putative neurotrophic factors in the protection of cisplatin-induced peripheral neuropathy in rats. Toxicol Appl Pharmacol 111:514–522
Roberts JA, Jenison EL, Kim K et al (1997) A randomized, multicenter, double-blind, placebo-controlled, dose-finding study of ORG 2766 in the prevention or delay of cisplatin-induced neuropathies in women with ovarian cancer. Gynecol Oncol 67:172–177
Markes M, Brockow T, Resch KL (2008) Exercise for women receiving adjuvant therapy for breast cancer (Review). The Cochrane Collection, Published by Wiley Ltd in The Cochrane Library, Issue 4
Irwin ML, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD, Kriska A, Ballard-Barbash R (2003) Physical activity levels before and after a diagnosis of breast carcinoma: the Healthy Eating, Activity, and Lifestyle (HEAL) study. Cancer 97(7):1746–1757
Herrero F, San Juan AF, Fleck SJ, Balmer J, Perez M, Canete S, Earnest CP, Foster C, Lucia A (2005) Combined aerobic and resistance training in breast cancer survivors: a randomized, controlled pilot trial. Int J Sports Med 26(4):294–302
Aitken DR, James AG (1997) Seromas and physiotherapy after mastectomy. Ann Surg Oncol 4(4):293–297
Schneider CM, Dennehy CA, Roozeboom M, Carter SD (2002) A model program: exercise intervention for cancer rehabilitation. Integr Cancer Ther 1:76–82
Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R (2007) Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment. Cancer 110:918–925
Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R (2007) Exercise training manages cardiopulmonary function and fatigue during and following cancer treatment in male cancer survivors. Integr Cancer Ther 6(3):235–241
Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R (2007) Cancer treatment-induced alterations in muscular fitness and quality of life: The role of exercise training. Ann Oncol 18:1957–1962
Balducci S, Iacobellis G, Parisi L, Di Biase N, Calandriello E, Leonetti F, Fallucca F (2006) Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Its Complicat 20:216–223
Richardson J, Sandman D, Vela S (2001) A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy. Arch Phys Med Rehabil 82:205–209
Tesfaye S, Harris ND, Wilson RM, Ward JD (1992) Exercise-induced conduction velocity increment: a marker of impaired peripheral nerve blood flow in diabetic neuropathy. Diabetologia 35:155–159
Lindeman E, Leffers P, Spaans F, Drukker J, Reulen J, Kerckhoffs M, Koke A (1995) Strength training in patients with myotonic dystrophy and hereditary motor and sensory neuropathy: a randomized clinical trial. Arch Phys Med Rehabil 76(7):612–620
Kilmer DD, McCroy MA, Wright NC, Aitkens SG, Bernauer EM (1994) The effect of a high resistance exercise program in slowly progressive neuromuscular disease. Arch Phys Med Rehabil 75(5):560–563
Aitkens SG, McCrory MA, Kilmer DD, Bernauer EM (1993) Moderate resistance exercise program: its effect in slowly progressive neuromuscular disease. Arch Phys Med Rehabil 74(7):711–715
Lindeman E, Leffers P, Reulen J, Spaans F, Drukker J (1998) Quadriceps strength and timed motor performances in myotonic dystrophy, Charcot-Marie-Tooth disease, and healthy subjects. Clin Rehabil 12(2):127–135
Boulton AJM, Malik RA, Arezzo JC, Sosenko JM (2004) Diabetic somatic neuropathies. Diabetes Care 27:1458–1486
Yong J, Loukianov E, Loukianova T, Jones LR, Periasamy M (1999) SERCA1a can functionally substitute for SERCA2a in the heart. Am J Physiol 276:H89–H97
Wu KD, Lee WS, Wey J, Bungard D, Lytton J (1995) Localization and quantification of endoplasmic reticulum Ca2+-ATPase isoform transcripts. Am J Physiol 269:C775–C784. Cell Physiol 38
Kleuber KM, Feczko JD (1994) Ultrastructural, histochemical, and morphometric analysis of skeletal muscle in a murine model of type I diabetes. Anat Rec 239:18–34
Racz G, Szabo A, Ver A, Zador E (2009) The slow sarco/endoplasmic reticulum Ca2+-ATPase declines independently of slow myosin in soleus muscle of diabetic rats. Acta Biochim Pol 56:487–493
Baselga J (2001) Herceptin® alone or in combination with chemotherapy in the treatment of HER2-positive metastatic breast cancer: pivotal trials. Oncology 61(suppl 2):14–21
Ullrich A, Schlessinger J (1990) Signal transduction by receptors with tyrosine kinase activity. Cell 61:203–212
Samantha A, LeVea CM, Dougall WC, Quian X, Greene MI (1994) Ligand and p185c-neu density govern receptor interactions and tyrosine kinase activation. Proc Natl Acad Sci USA 91:1711–1715
McGuire JF, Ruen S, Siegfreid E, Wright DE, Dobrowsky RT (2009) Caveolin-1 and altered neuregulin signaling contribute to the pathophysiological progression of diabetic peripheral neuropathy. Diabetes 58:2677–2686
Yatime L, Buch-Pedersen MJ, Musgaard M et al (2009) P-type ATPases as drug targets: tools for medicine and science. Biophysica Acta 1787:207–220
Cook-Burns N (2001) Retrospective analysis of the safety of Herceptin® immunotherapy in metastatic breast cancer. Oncology 61(suppl 2):58–66
Feldman AM, Lorell BH, Reis SE (2000) Trastuzumab in the treatment of metastatic breast cancer: anticancer therapy versus cardiotoxicity. Circulation 102:272–274
Holbro T, Beerli RR, Maurer F, Koziczak M, Barbas CF, Hynes NE (2003) The ErbB2/ErbB3 heterodimer functions as an oncogenic unit: ErbB3 to drive breast tumor cell proliferation. Proc Natl Acad Sci USA 100(15):8933–8938
Gustafsson T, Puntschart A, Kaijser L, Lansson E, Sundberg CJ (1999) Exercise-induced expression of angiogenesis-related transcription and growth factors in human skeletal muscle. Am J Physiol 276:H679–H685
Fukai T, Siegfried MR, Ushio-Fukai M, Cheng Y, Kojda G, Harrison DG (2000) Regulation of the vascular extracellular superoxide dismutase by nitric oxide and exercise training. J Clin Invest 105:1631–1639
Wisloff U, Loennechen JP, Falck G, Veisvag V, Currie S, Smith G, Ellingsen O (2001) Increased contractility and calcium sensitivity in cardiac myocytes isolated from endurance trained rats. Cardiovasc Res 50:495–508
Tate CA, Taffet GE, Hudson EK, Blaylock SL, McBride RP, Michael LH (1990) Enhanced calcium uptake of cardiac sarcoplasmic reticulum in exercise-trained old rats. Am J Physiol 258:H431–H435. Heart Circ Physiol 27
Tate CA, Helgason T, Hyek MF, McBride RP, Chen M, Richardson MA, Taffet GE (1996) SERCA2a and mitochondrial cytochrome oxidase expression are increased in hearts of exercise-trained old rats. Am J Physiol 271:H68–H72. Heart Circ Physiol 40
Wonders KY, Hydock DS, Greufe S, Schneider CM, Hayward R (2009) Endurance training preserves cardiac function in rats receiving doxorubicin and the HER2-inhibitor GW2974. Cancer Chemother Pharmacol 64(6):1105–1113
Obrosova IG, Drel VR, Pacher P et al (2005) Oxidative-nitrosative stress and poly(ADP-Ribose) polymerase PPARP) activation in experimental diabetic neuropathy: the relation is revisited. Diabetes 54:3435–3441
Obrosova IG, Drel VR, Oltman CL et al (2007) Rose of nitrosative stress in early neuropathy and vascular dysfunction in streptozotcin-diabetic rats. Am J Physiol Endocrinol Metab 293:E1645–E1655
Koltyn KF, Wertz AL, Gardiner RL et al (1996) Perception of pain following aerobic exercise. Med Sci Sports Exerc 28:1418–1421
Gurevich M, Kohn PM, Davis C (1994) Exercise-induced analgesia and the role of reactivity in pain sensitivity. J Sports Sci 12:549–559
Sternberg WF, Bokat C, Kass L et al (2001) Sex-dependent components of the analgesia produced by athletic competition. Pain 94:65–74
Sternberg WF, Bailin D, Grant M et al (1998) Competition alters the perception of noxious stimuli in male and female athletes. Pain 76:231–238
Haier RJ, Quaid K, Mills JSC (1981) Naloxone alters pain perception after jogging. Psychiatry Res 5:231–232
Koltyn KF, Arbogast RW (1998) Perception of pain after resistance exercise. Br J Sports Med 32:20–24
Carter GT, Kikuchi N, Abresch RT, Walsh SA, Horasek S, Fowler WM (1994) Effects of exhaustive concentric and eccentric exercise on murine skeletal muscle. Arch Phys Med Rehabil 75:555–559
Carter GT, Abresch RT, Fowler WM (2002) Adaptations to exercise training and contraction-induced muscle injury in animal models of neuromuscular disease. Am J Phys Med Rehabil 81(suppl):S151–S161
Breslin E, Booth J, Lord B et al (1993) Respiratory responses to unsupported arm exercise (UAE) in Charcot Marie Tooth (CMT) [abstract]. American Thoracic Society. Am Rev Respir Dis 147:A532
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Wonders, K.Y., Reigle, B.S. & Drury, D.G. Treatment strategies for chemotherapy-induced peripheral neuropathy: potential role of exercise. Oncol Rev 4, 117–125 (2010). https://doi.org/10.1007/s12156-010-0044-1
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DOI: https://doi.org/10.1007/s12156-010-0044-1