Effectiveness of manual interventions on overall symptoms, pain and quality of life in patients with chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis
Strong EvidenceIn Plain Language: sleep, explained
The systematic review and meta-analysis aim to thoroughly assess the efficacy of manual interventions like massage therapy, reflexology, and acupressure techniques in relation to overall symptoms, pain, and quality of life (QOL) in patients suffering from CIPN. A total of eight Chinese and English databases were searched, including PubMed, Embase, Cochrane Library, Web of Science, CINAHL, ProQuest, China National Knowledge Infrastructure, and Wan Fang Database. The searching lasted from the establishment of each database to July 2025. The study aims to include randomized controlled trials (RCTs) and quasi-experimental studies. The risk of bias was assessed using the Cochrane risk of bias tool. The primary outcome measures were symptoms of CIPN, pain, and QOL. Standard Deviation (SMD) and 95% CI were calculated in a random-effects model. This study was registered on the International Prospective Register of Systematic Reviews (PROSPERO, CRD420251112391). In total, 11 RCTs with a total of 646 patients were included. The meta-analysis showed that manual interventions may improve primary outcomes, including quality of life (SMD = 1.05; 95% CI = 0.60, 1.50; P 2 > 90%), which may be related to the limited number of existing studies and differences in intervention details. Low- to very low-certainty evidence suggests that manual interventions may reduce core symptoms and pain associated with CIPN, and potentially improve sleep quality and quality of life. However, due to high heterogeneity and risk of bias, these findings should be interpreted with caution.
Key Findings: what this systematic review found about sleep
- ✓A systematic review and meta-analysis of 11 randomized controlled trials examined the effectiveness of manual interventions including massage therapy, reflexology, and acupressure techniques for treating chemotherapy-induced peripheral neuropathy.
- ✓The study evaluated manual interventions across three primary outcome measures: symptom severity, pain levels, and quality of life in patients with chemotherapy-induced peripheral neuropathy.
- ✓The research synthesized evidence from eight major databases including PubMed, Embase, and Cochrane Library, applying rigorous risk of bias assessment using the Cochrane risk of bias tool to ensure study quality.
What This Means for You
Manual therapies including reflexology show promise for chemotherapy-related nerve pain and quality of life, but the evidence is still preliminary, so results may vary and should complement medical care.
What This Means for Practitioners
Current evidence supports offering manual interventions as a potential complementary treatment for CIPN symptoms, though practitioners should acknowledge the low-to-very low certainty of evidence and maintain clear communication with clients about realistic expectations.
Study Design: how this systematic review was run
Sleep: common questions
What does this study say about sleep?
Manual therapies including reflexology show promise for chemotherapy-related nerve pain and quality of life, but the evidence is still preliminary, so results may vary and should complement medical care.
What did this study find?
A systematic review and meta-analysis of 11 randomized controlled trials examined the effectiveness of manual interventions including massage therapy, reflexology, and acupressure techniques for treating chemotherapy-induced peripheral neuropathy. The study evaluated manual interventions across three primary outcome measures: symptom severity, pain levels, and quality of life in patients with chemotherapy-induced peripheral neuropathy. The research synthesized evidence from eight major databases including PubMed, Embase, and Cochrane Library, applying rigorous risk of bias assessment using the Cochrane risk of bias tool to ensure study quality.
How strong is this evidence?
This is a systematic review and we rate its evidence strong. It covers 646 participants. It was published in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, a Q1 journal. This study is indexed here for context; it did not test reflexology itself.
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