Yoga May Reduce Neuropathic Pain Caused by Chemotherapy

A side effect of chemotherapy, widely used to treat cancer, is peripheral neuropathy, which damages nerves in the hands and feet. It affects around 70% of patients to varying degrees during chemotherapy. Severity depends on the medicine and dose and may require dose reduction or stopping treatment.

In 2020, Journal of the National Cancer Institute published a study evaluating the effectiveness of yoga for chemotherapy-induced neuropathic pain and fall risk.

Study Details

The study included people over 18 with breast, ovarian, uterine or endometrial cancer who had completed neurotoxic chemotherapy at least 3 months earlier. Participants scored 4 or higher for tingling, numbness or pain on an 11-point scale, indicating moderate-to-severe chemotherapy-induced neuropathic pain (CINP).

The 41 participants were divided into two groups: 21 in the yoga group and 20 receiving usual care.

• The yoga group practised for 60 minutes daily for 8 weeks, a duration recommended in previous cancer studies. The 8-week programme included in-person group classes twice weekly and home practice on the other days, 5 times weekly. 
• The usual-care group received no neuropathy treatment for 12 weeks.

The yoga protocol combined breathing exercises (pranayama) and adaptable postures (asanas) to improve flexibility, strength and balance. By increasing parasympathetic activation, the selected asanas targeted circulation, aerobic capacity, joint strength, spinal flexibility, core strength, balance and proprioception. 

Groups were assessed at weeks 4, 8 and 12.

Yoga Reduces Chemotherapy-Induced Neuropathic Pain

The results showed a substantial reduction in pain scores among yoga participants. 

• At week 8, mean pain scores in the yoga group had fallen by 1.95 points from baseline. 
• At week 12, mean pain scores in the yoga group had fallen by 2.03 points. 
• The usual-care group did not show such a marked change in pain scores.

The study suggests yoga exercises may help reduce chemotherapy-induced neuropathic pain and fall risk. Yoga may improve quality of life and help people with cancer cope with adverse effects.

At week 8, patients in the yoga group also reported using fewer painkillers than those receiving usual care, but the difference was not statistically significant.

Conclusion

The results suggest a clinically meaningful effect on CINP pain. Currently, the only CINP intervention supported by American Society of Clinical Oncology guidelines is medication containing duloxetine. 

This study suggests that yoga may be “a promising, drug-free approach” to improving CINP pain. However, further research with larger samples and longer follow-up remains important. 

The precise mechanism by which yoga relieves CINP is not fully understood, but two hypotheses have been proposed: 

• First, yoga may provide neuroprotective effects by increasing blood flow and oxygen supply. 
• Second, mindfulness and breathing exercises may influence the parasympathetic nervous system by regulating sympathetic activity through the hypothalamic–pituitary–adrenal axis.

In conclusion, yoga appeared safe among breast and gynaecological cancer survivors with moderate-to-severe CINP. It also showed promise for pain, quality of life and physical function. An adequately powered randomised controlled trial with a larger sample, longer follow-up and an appropriate control group is needed to confirm specific, long-term effects on CINP symptoms and fall risk.