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L i s te n to T h e A B M P Po d c a s t a t a b m m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 35 PATHOLOGY PERSPECTIVES and, interestingly, as a possible preventive measure. Following is a brief overview of some of the studies I found most interesting, but others are provided in the resource list. Case Report: Patient with CIPN Treated with Manual Therapy (Massage) 1 This case report, which was a winner in the Massage Therapy Foundation Case Report Contest, is about a massage therapist whose client had moderate CIPN that was reduced to mild, along with improvements in quality of life and objective changes in the temperature of their extremities, after a course of massage therapy. The report gives some nice descriptions of the sessions that could be helpful to other massage therapists. Prevention of CIPN with Classical Massage in Breast Cancer Patients Receiving Paclitaxel: An Assessor- Blinded Randomized Controlled Trial 2 In this clinical trial, 40 women with breast cancer were randomized to an experimental group or control group before they started chemotherapy, to track whether massage might make a difference. The control group had predictable accumulation of symptoms over time, but the massage group did not. This led the researchers to suggest that massage therapy could be used as a preventive measure, if it can be provided before chemotherapy treatments begin. (Note: This synopsis is accurate but very simplified; this extremely complex project had several other interesting findings.) Healing Hands: Massage Therapy Can Offer Relief for CIPN Symptoms 3 This review of an abstract presented at the 2016 Palliative Care in Oncology Symposium describes a study in which 62 patients participated to look at massage for cancer patients with CIPN. The results varied, depending on the specific CIPN symptom. Little change was found in symptoms that involved buzzing or ringing in the ears, but overall weakness, numbness, and tingling in the feet—as well as difficulty walking—were all substantially improved. Further, of those who enrolled in the study who didn't already have CIPN, 97 percent remained pain-free. This study lacked a control group for comparison, but it certainly points to some interesting possibilities. A THOUGHT TO CONSIDER . . . AND SOME TAKEAWAYS It seems reasonable to suggest, based on the research, that careful, skilled massage therapy may be a viable option for at least some people with CIPN. Massage might also make some patients' cancer treatment more tolerable, leading to better outcomes. But how does it work? Massage is unlikely to undo the damage caused by neurotoxic medication—that nerve damage can be permanent, with long-term impairment and signs of inflammation in both central and peripheral systems—but I am curious about whether CIPN, especially when it persists for months and years after cancer treatment is finished, might be connected to another chronic pain pattern: central sensitization. In central sensitization, aspects of the CNS physically change. We grow new sensory dendrites, and we secrete different neurotransmitters, and these changes make us more likely sensitized to interpret incoming signals as pain. In short, being in pain makes someone with central sensitization more likely to experience more pain: It becomes a self-fulfilling prophecy. I was unable to find any research that links long-term CIPN directly to central sensitization, but I did find a study that looked at connections between diabetic neuropathy and this CNS overreaction to incoming signals. This makes me wonder if CIPN might have some aspects of central sensitization as well. This possible connection between CIPN and the CNS is interesting to contemplate because we know that skillful manual therapy, including various forms of massage, turns out to be helpful for some situations where central sensitization has ingrained the experience of pain. Our work, with its impact on physical, mental, and emotional well-being, is especially suited for people who live with chronic, intractable pain. We can, through welcomed and educated touch, help "turn down the volume" on central sensitization, which, along with other self-help strategies, can make the whole experience more manageable. Will massage therapy solve the problem of CIPN for all patients? Almost certainly not. But with skill, sensitivity, and curiosity, we might be able to lessen this problem for many patients. And that is worth pursuing. Notes 1. Joan Elizabeth Cunningham et al., "Case Report of a Patient with Chemotherapy- Induced Peripheral Neuropathy Treated with Manual Therapy (Massage)," Supportive Care in Cancer 19, no. 9 (July 2011): 1,473–76, 2. Nur Izgu et al., "Prevention of Chemotherapy- Induced Peripheral Neuropathy with Classical Massage in Breast Cancer Patients Receiving Paclitaxel: An Assessor-Blinded Randomized Controlled Trial," European Journal of Oncology Nursing 40 (March 2019): 36 –43, 3. Allie Casey, "Healing Hands: Massage Therapy Can Offer Relief for CIPN Symptoms," Oncology Nursing News (September 17, 2016), view/healing-hands-massage-therapy- can-offer-relief-for-cipn-symptoms. Ruth Werner is a former massage therapist, a writer, and an NCBTMB- approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (available at booksofdiscovery. com), now in its seventh edition, which is used in massage schools worldwide. Werner is also the host of the podcast I Have a Client Who . . . on The ABMP Podcast Network. She is available at or

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