Efficacy and Proposed Mechanisms of Electroacupuncture in Animal Models of Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis.

Abstract

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting toxicity of chemotherapy with few effective treatment options. Electroacupuncture (EA) has demonstrated promising clinical efficacy, yet its preclinical evidence remains fragmented, limiting mechanistic understanding and translational application. This systematic review and meta-analysis evaluated the efficacy of EA in animal models of CIPN and synthesized the underlying mechanisms.

Methods: Seven databases were systematically searched from inception to June 24, 2026, for controlled animal studies investigating EA for CIPN. The primary outcome was mechanical withdrawal threshold (MWT); secondary outcomes included thermal withdrawal latency (PWL), adhesive removal test (ART) responsive time, sciatic nerve conduction velocity (SNCV), and intra-epidermal nerve fiber density (IENFs). Methodological quality was assessed using SYRCLE, and reporting quality using ARRIVE 2.0. Meta-analyses were conducted by Stata 18.0 and R 4.5.2.

Results: 21 studies involving 451 animals were included. SYRCLE scores ranged from 6 to 7, and ARRIVE scores from 9.5 to 15.5, indicating moderate quality. Meta-analysis revealed that EA significantly increased MWT (standardized mean difference [SMD] = 4.34, 95% confidence interval [CI]: 3.34 to 5.34, I ² = 78.5%) and PWL (SMD = 5.86, 95% CI: 3.97 to 7.75, I ² = 78.2%) compared to model group. EA also significantly shortened ART responsive time (SMD = -3.76, 95% CI: -6.69 to -0.83, I ² = 88.0%), improved SNCV (SMD = 5.56, 95% CI: 4.10 to 7.02, I ² = 0%) and preserved IENFs (SMD = 3.39, 95% CI: 2.34 to 4.45, I ² = 0%). Mechanistically, EA attenuated neuroinflammation, modulated ion channels, activated antioxidant pathways, and regulated neurotransmitter release.

Conclusion: Preclinical evidence demonstrates that EA effectively alleviates pain-like behaviors, improves sensory recovery, and enhances neurological function in CIPN models through multi-target mechanisms. These findings support EA as a promising intervention warranting further research.