Nutraceutical Protocols: 

Chemotherapy-Induced Peripheral Neuropathy (CIPN)

  Important:

  • No nutraceutical is recommended for CIPN prevention (per ASCO guidelines.[5]
  • Duloxetine (Ccymbalta) is the only agent with demonstrated efficacy (moderate recommendation)
  • Despite the negative guideline recommendations for prevention, the pathophysiology of CIPN involves several mechanisms that nutraceuticals may address, particularly for symptom management and supportive care:

 

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Nutraceutical Protocols: 

 

 

  

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Definitions and Terms Related to Pain

 

Nutraceutical Protocol:

Chemotherapy-Induced Peripheral Neuropathy (CIPN)

Introduction

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatments, affecting 30–68% of patients receiving drugs like taxanes or platinum agents. It causes numbness, tingling, and burning pain in the hands and feet, often with weakness or digestive issues, significantly reducing quality of life and sometimes leading to reduced chemotherapy doses or discontinuation of treatment.

While duloxetine (Cymbalta) offers moderate pain relief for many, its side effects may include fatigue (9%), insomnia (9%) and nausea that can limit its use for some patients. Other drugs, such as gabapentin, pregabalin (Lyrica) generally show little to no benefit for CIPN. 

For these reason,s many patients turn to acupuncture as a means of helping them with their pain and other symptoms associated with CIPN.

Targeting the Sources of Symptoms with Nutraceuticals

  Multiple pathologic processes are involved in the production of side effects associated with chemotherapy:

  • Mitochondrial Dysfunction
  • Oxidative Stress/peroxynitrite production
  • Neuroinflammation (glial activation, cytokine release)
  • Axonal degeneration
  • Dorsal root ganglion neurotoxicity,
  • Ion channel dysfunction (sodium, calcium)
  • Microtubule disruption, DNA damage
  • Axon degeneration

 

  1. Clinical Context: CIPN is a dose-limiting toxicity affecting approximately 30–50% of patients receiving neurotoxic chemotherapy, with some agents (oxaliplatin) causing neuropathy in up to 90% of patients.[1][2][3] The most common causative agents include taxanes (paclitaxel, docetaxel), platinum compounds (oxaliplatin, cisplatin), vinca alkaloids (vincristine), and proteasome inhibitors (bortezomib).[1][4][2] CIPN can persist for months to years after treatment completion and significantly impacts quality of life.[2][3]
  2. Currently, no FDA-approved preventive agents exist, and duloxetine is the only treatment with demonstrated efficacy for established CIPN.[5]

—

Critical Guideline Context

  • The 2020 ASCO Guideline Update on CIPN prevention and management provides important context for nutraceutical recommendations:[5]
  • Agents NOT recommended for CIPN prevention (evidence-based, no benefits):
    1. Acetyl-L-carnitine (ALC) – may worsen CIPN
    2. Alpha-lipoic acid (ALA)
    3. Calcium/magnesium infusions
    4. Glutathione
    5. N-acetyl cysteine (NAC)
    6. Vitamin B
    7. Vitamin E
    8. Omega-3 fatty acids

   For established CIPN treatment:

  • Duloxetine is the only agent with demonstrated efficacy (moderate recommendation)

—

MECHANISTIC RATIONALE FOR NUTRACEUTICAL APPROACH

Despite the negative guideline recommendations for prevention, the pathophysiology of CIPN involves several mechanisms that nutraceuticals may address, particularly for symptom management and supportive care:

1. Mitochondrial dysfunction: ATP depletion, mitochondrial swelling, and bioenergetic deficits are central to CIPN pathogenesis. CoQ10 and melatonin support mitochondrial function.[6][7] [Alpha lipoic acid (ALA) ASCO recommends against – No benefit; poor tolerability (only 29% completion rate in one study);

2. Oxidative stress/peroxynitrite: Peroxynitrite is a highly toxic free radical that drives CIPN across drug classes. Antioxidants (melatonin, N-acetyl cysteine (NAC), alpha lipoic acid (ALA) may address this mechanism.[6]

3. Neuroinflammation: Glial cell activation (microglia, astrocytes), cytokine release (TNF-α, IL-1β, IL-6), and mast cell activation contribute to CIPN. PEA, omega-3, and curcumin target neuroinflammation.[8][9]

4. Endocannabinoid system dysregulation: Paclitaxel reduces spinal cord PEA levels. PEA supplementation may restore endocannabinoid tone.[10]

5. Gut microbiome dysbiosis: Chemotherapy-induced dysbiosis may contribute to neuroinflammation. Probiotics may address this mechanism.[1][9]

—

IMPORTANT CAVEATS:

    1. No nutraceutical is recommended for CIPN prevention per ASCO guidelines[5]
    2. Acetyl-L-carnitine should be AVOIDED as it may worsen CIPN[5][11]
    3. Nutraceuticals should complement, not replace, duloxetine and other evidence-based treatments

Supportive Care and Symptom Management

The following protocol is for supportive care and symptom management in patients with established CIPN

—

Tier 1: Agents with Emerging Evidence (Use with Caution)

Agent

Dosing Protocol

Evidence Level

Mechanism/Rationale

References

Omega-3 (EPA/DHA)

1.5–2 g daily

Preclinical positive; limited clinical

Reduces neuroinflammation; prevents spinal microglia activation; normalizes cytokines and BDNF; one RCT showed reduced CIPN incidence

[1], [2], [3]

Melatonin

3–10 mg QHS

Strong preclinical; no clinical trials

Prevents mitochondrial dysfunction; reduces oxidative stress; protects against paclitaxel and vincristine neuropathy; additive with duloxetine in preclinical models

[4], [5], [6], [7]

PEA (Palmitoylethanolamide)

600 mg BID (ultramicronized)

Preclinical positive; mixed clinical

Reduces glial activation; restores myelinated fiber function; paclitaxel reduces spinal PEA levels; one clinical study showed improved nerve function

[7], [8], [9], [10], [11]

Vitamin D3

Optimize to 25(OH)D 40–60 ng/mL

Supportive care

Deficiency common in cancer patients; supports nerve function; no direct CIPN evidence

[Document]

[23][24][25][26][27][28][29][10][30][31][32][33][34][35][36]

Omega-3 Evidence: A 2025 preclinical study found omega-3-enriched fish oil prevented cold and mechanical hypersensitivity in both oxaliplatin and paclitaxel CIPN models, with reduced spinal cord microglia activation and decreased cytokine levels.[23] A single moderate-size RCT showed patients receiving omega-3 were less likely to develop peripheral neuropathy, though severity was not different.[37] The SIO-ASCO guideline notes “insufficient evidence to recommend for or against.“[37]

Melatonin Evidence: Strong preclinical evidence demonstrates melatonin prevents paclitaxel-induced mitochondrial dysfunction, reduces oxidative stress, and protects against neuropathic pain without affecting chemotherapy cytotoxicity.[35] Melatonin showed additive effects with duloxetine in preclinical models.[35] Melatonin also protected against vincristine-induced neuropathy by inhibiting TNF-α/astrocyte/microglial activation.[33]

PEA Evidence: Preclinical studies show PEA reverses paclitaxel-induced allodynia and prevents oxaliplatin-induced neuropathy by reducing glial activation.[27][28] Paclitaxel reduces spinal cord PEA levels, suggesting endocannabinoid dysregulation.[10] However, a 2024 phase II RCT found PEA failed to improve established CIPN (n=88), though the authors suggest it may be more effective for prevention rather than treatment.[38] An earlier clinical study showed PEA restored myelinated fiber function in patients with bortezomib/thalidomide-induced neuropathy.[32]

—

Tier 2: Antioxidant Support (Theoretical Benefit)

Agent

Dosing Protocol

Evidence Level

Mechanism/Rationale

References

Magnesium

400 mg daily (oral)

NMDA antagonism; supportive

May help with muscle cramps; NMDA receptor modulation; IV Ca/Mg NOT recommended for prevention

[1], [2]

B-Complex

Daily

Supportive care

Deficiency common in cancer patients; neural support; conflicting evidence for CIPN

[3]

CoQ10

200–300 mg daily

Theoretical; no CIPN trials

Mitochondrial support; addresses bioenergetic deficits

[Document]

[5][39][40]

Notes:

  • Calcium/Magnesium Infusions: The 2020 ASCO guideline recommends against IV calcium/magnesium for CIPN prevention based on a definitive phase III trial (N08CB) showing no benefit.[5][40] Earlier positive studies were superseded by this larger trial.[5]
  • Anti-Oxidative Stress Therapies: A 2025 meta-analysis found anti-oxidative stress treatments (various agents) were associated with significant reduction of grade ≥2 oxaliplatin-induced neuropathy (OR 0.04, 95% CI 0.01-0.12, p<0.00001), though evidence quality was limited.[41]

—

Tier 3: Agents to AVOID

Agent

Recommendation

Evidence

References

Acetyl-L-Carnitine (ALC)

DO NOT USE

Phase III RCT: ALC worsened CIPN at 24 weeks; significantly worse FACT-NTX scores; more grade 3-4 neurotoxicity

[1], [2], [3]

Alpha-Lipoic Acid (ALA)

Not recommended

RCT: No benefit; poor tolerability (29% completion rate); ASCO recommends against

[4], [5]

Vitamin E

Not recommended

Conflicting evidence; ASCO recommends against; may increase prostate cancer risk

[6], [7]

Glutathione

Not recommended

ASCO recommends against

[7]

[5][25][26][42][11]

  • Acetyl-L-Carnitine Warning: A landmark phase III RCT (n=409) found ALC (3000 mg/day) significantly worsened CIPN at 24 weeks compared to placebo, with more grade 3-4 neurotoxicity.[11] Long-term follow-up confirmed statistically significantly worse CIPN over 2 years.[5]
  • Patients should be actively discouraged from using ALC.[11]

—

CHEMOTHERAPY-SPECIFIC CONSIDERATIONS

Chemotherapy

CIPN Characteristics

Nutraceutical Considerations

References

Taxanes (paclitaxel, docetaxel)

Sensory > motor; acute pain syndrome; microtubule disruption

Melatonin (preclinical positive);

PEA (preclinical positive); Omega-3;

AVOID ALC

[1], [2], [3], [4]

Platinum (oxaliplatin, cisplatin)

Acute cold sensitivity; chronic sensory ataxia; may worsen after discontinuation

Omega-3; Melatonin; anti-oxidative stress therapies may help;

Ca/Mg NOT recommended;

[5], [6], [7]

Vinca alkaloids (vincristine)

Sensory + motor; autonomic dysfunction

Melatonin (preclinical positive);

DHA (preclinical positive)

[7], [8]

Proteasome inhibitors (bortezomib)

Painful neuropathy; may be reversible

PEA (clinical evidence for myelinated fiber function)

[9]

[1][4][43][2][23][24][27][32][33][35]

—

COMPREHENSIVE CIPN SUPPORTIVE CARE PROTOCOL

Phase 1: During Chemotherapy (Supportive Care)

   Goal: Optimize nutritional status; support mitochondrial function

  • Vitamin D3: Check 25(OH)D; optimize to 40–60 ng/mL
  • Magnesium (oral): 400 mg daily (glycinate or citrate)
  • B-Complex: Daily
  • Omega-3: 1.5–2 g EPA+DHA daily (discuss with oncologist)
  • Melatonin: 3–5 mg QHS (may help with sleep disruption common during chemotherapy)

DO NOT USE: Acetyl-L-carnitine, high-dose vitamin E

Phase 2: Established CIPN (Symptom Management)

   Goal: Multimodal approach to symptom control

First-line pharmacotherapy: Duloxetine 30–60 mg daily (ASCO-recommended)[5]

Adjunctive nutraceuticals:

    1. PEA (ultramicronized): 600 mg BID (may help with neuropathic symptoms; limited clinical evidence)
    2. Melatonin: 5–10 mg QHS (sleep, antioxidant support)
    3. Omega-3: 2 g daily (anti-inflammatory)
    4. Magnesium: 400–600 mg daily (NMDA modulation, muscle cramps)
    5. Continue Vitamin D3 optimization

Phase 3: Chronic/Persistent CIPN (Long-term Management)

   Goal: Address ongoing symptoms; support nerve recovery

  1.  Continue effective agents from Phase 2
  2.  Consider adding CoQ10: 200–300 mg daily (mitochondrial support)
  3. – Consider adding Curcumin: 500 mg TID (anti-inflammatory)

—

EMERGING THERAPIES

Agent

Evidence

Status

References

Cannabidiol (CBD)

Phase III RCT: 135 mg/day reduced numbness/tingling vs placebo; no effect on pain or motor function

Promising for sensory symptoms

[1]

Traditional Chinese Herbal Medicine

Meta-analysis of 37 RCTs: Reduced CIPN incidence vs placebo/usual care; Astragali Radix + Cinnamomi Ramulus strongest combination

Moderate evidence; primarily Asian studies

[2]

Cryotherapy

Emerging evidence for prevention during taxane infusion

Under investigation

[3]

Exercise

Emerging evidence for prevention and treatment

Under investigation

[4]

[44][45][5][46]

  • Traditional Chines Herbal Medicine: Astragali Radix + Cinnamomi Ramulus the strongest combination, may be used synergistically with duloxetine. The herbal pair appears to offer superior preventive measures against CIPN, whereas duloxetine offers superior symptomatic relief with established CIPN
  • CBD Evidence: A phase III RCT (n=46 completers) found CBD 135 mg/day reduced numbness/tingling and improved sensory function compared to placebo, without affecting pain or motor function.[45] CBD was well-tolerated without serious adverse events.

—

MONITORING AND ASSESSMENT

   Baseline Assessment:

  • CIPN severity: EORTC QLQ-CIPN20, FACT-Ntx, NCI-CTCAE grading
  • Neurological examination: sensory testing, reflexes, strength
  • Functional status: gait, fine motor function
  • Laboratory: 25(OH)D, B12, folate, glucose (rule out other causes of neuropathy)

   During Chemotherapy:

  • Monitor for CIPN symptoms at each cycle
  • Document cumulative dose
  • Consider dose modification if grade 2+ neuropathy develops

   Follow-up for Established CIPN:

  • Monthly assessment for first 3 months
  • CIPN20 or FACT-Ntx scores
  • Functional status
  • Response to duloxetine and adjunctive therapies

Expected Timeline:

  • CIPN may worsen for weeks after platinum discontinuation (“coasting”)[2]
  • Recovery is variable; some patients have persistent symptoms for years[3]
  • Nutraceutical benefits, if any, may take 4–8 weeks to manifest

—

SPECIAL CONSIDERATIONS

Interaction with Chemotherapy Efficacy: A critical concern with any CIPN intervention is potential interference with chemotherapy efficacy.

   The following have been shown NOT to reduce chemotherapy efficacy:

  • Acetyl-L-carnitine should be avoided not only because it worsens CIPN but also because of the principle of avoiding unproven supplements during active cancer treatment.[11]

Drug Interactions:

  • Omega-3 (high dose): May increase bleeding risk with anticoagulants
  • Melatonin: May interact with immunosuppressants; generally safe
  • PEA: No significant drug interactions reported
  • Magnesium: May reduce absorption of certain antibiotics and bisphosphonates

Cancer Survivorship: CIPN can persist long after chemotherapy completion. The nutraceutical approach for chronic CIPN in survivors is similar to other neuropathic pain conditions, with emphasis on:

  • Vitamin D optimization
  • Omega-3 supplementation
  • PEA for neuropathic symptoms
  • Melatonin for sleep and antioxidant support

References

  1. Current Understanding of the Molecular Mechanisms of Chemotherapy-Induced Peripheral Neuropathy. Chen X, Gan Y, Au NPB, Ma CHE. Frontiers in Molecular Neuroscience. 2024;17:1345811. doi:10.3389/fnmol.2024.1345811.
  2. Peripheral Neuropathy. Mauermann ML, Staff NP. JAMA. 2026;335(3):255-266. doi:10.1001/jama.2025.19400.
  3. Long-Term Effects, Pathophysiological Mechanisms, and Risk Factors of Chemotherapy-Induced Peripheral Neuropathies: A Comprehensive Literature Review. Kerckhove N, Collin A, Condé S, et al. Frontiers in Pharmacology. 2017;8:86. doi:10.3389/fphar.2017.00086.
  4. Sodium Channel Modulation as a Therapeutic Strategy for Chemotherapy-Induced Peripheral Neurotoxicity. Di Girolamo S, Terribile G, Alberti P, Cavaletti G. Expert Opinion on Investigational Drugs. 2025;. doi:10.1080/13543784.2025.2586615.
  5. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update. Loprinzi CL, Lacchetti C, Bleeker J, et al. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2020;38(28):3325-3348. doi:10.1200/JCO.20.01399.
  6. Bioenergetic Deficits in Peripheral Nerve Sensory Axons During Chemotherapy-Induced Neuropathic Pain Resulting From Peroxynitrite-Mediated Post-Translational Nitration of Mitochondrial Superoxide Dismutase. Janes K, Doyle T, Bryant L, et al. Pain. 2013;154(11):2432-2440. doi:10.1016/j.pain.2013.07.032.
  7. Mini-Review: Mitochondrial Dysfunction and Chemotherapy-Induced Neuropathic Pain. Doyle TM, Salvemini D. Neuroscience Letters. 2021;760:136087. doi:10.1016/j.neulet.2021.136087.
  8. Neuroinflammatory Process Involved in Different Preclinical Models of Chemotherapy-Induced Peripheral Neuropathy. Fumagalli G, Monza L, Cavaletti G, Rigolio R, Meregalli C. Frontiers in Immunology. 2020;11:626687. doi:10.3389/fimmu.2020.626687.
  9. The Role of the Gut Microbiome in Neuroinflammation and Chemotherapy-Induced Peripheral Neuropathy. Shatunova S, Aktar R, Peiris M, et al. European Journal of Pharmacology. 2024;979:176818. doi:10.1016/j.ejphar.2024.176818.
  10. N-Acylethanolamine-Hydrolysing Acid Amidase: A New Potential Target to Treat Paclitaxel-Induced Neuropathy. Toma W, Caillaud M, Patel NH, et al. European Journal of Pain (London, England). 2021;25(6):1367-1380. doi:10.1002/ejp.1758.
  11. Randomized Double-Blind Placebo-Controlled Trial of Acetyl-L-Carnitine for the Prevention of Taxane-Induced Neuropathy in Women Undergoing Adjuvant Breast Cancer Therapy. Hershman DL, Unger JM, Crew KD, et al. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2013;31(20):2627-33. doi:10.1200/JCO.2012.44.8738.
  12. Pain in Multiple Sclerosis: Understanding Pathophysiology, Diagnosis, and Management Through Clinical Vignettes. Racke MK, Frohman EM, Frohman T. Frontiers in Neurology. 2021;12:799698. doi:10.3389/fneur.2021.799698.
  13. Identifying and Treating Pain Caused by MS. Wright LJ. The Journal of Clinical Psychiatry. 2012;73(7):e23. doi:10.4088/JCP.11093nr1c.
  14. Pharmacological and Non-Pharmacological Approaches for the Management of Neuropathic Pain in Multiple Sclerosis. Shkodina AD, Bardhan M, Chopra H, et al. CNS Drugs. 2024;38(3):205-224. doi:10.1007/s40263-024-01072-5.
  15. Central Amygdala Inflammation Drives Pain Hypersensitivity and Attenuates Morphine Analgesia in Experimental Autoimmune Encephalomyelitis. Dworsky-Fried Z, Faig CA, Vogel HA, Kerr BJ, Taylor AMW. Pain. 2022;163(1):e49-e61. doi:10.1097/j.pain.0000000000002307.
  16. Multiple Sclerosis. Reich DS, Lucchinetti CF, Calabresi PA. The New England Journal of Medicine. 2018;378(2):169-180. doi:10.1056/NEJMra1401483.
  17. CaMKIIα Mediates the Effect of IL-17 to Promote Ongoing Spontaneous and Evoked Pain in Multiple Sclerosis. Hu X, Huang F, Wang ZJ. The Journal of Neuroscience : The Official Journal of the Society for Neuroscience. 2018;38(1):232-244. doi:10.1523/JNEUROSCI.2666-17.2017.
  18. Use of Vitamins and Dietary Supplements by Patients With Multiple Sclerosis: A Review. Evans E, Piccio L, Cross AH. JAMA Neurology. 2018;75(8):1013-1021. doi:10.1001/jamaneurol.2018.0611.
  19. Role of Lipoic Acid in Multiple Sclerosis. Xie H, Yang X, Cao Y, et al. CNS Neuroscience & Therapeutics. 2022;28(3):319-331. doi:10.1111/cns.13793.
  20. Resveratrol Defends Blood-Brain Barrier Integrity in Experimental Autoimmune Encephalomyelitis Mice. Wang D, Li SP, Fu JS, et al. Journal of Neurophysiology. 2016;116(5):2173-2179. doi:10.1152/jn.00510.2016.
  21. Endoplasmic Reticulum Stress in the Dorsal Root Ganglia Regulates Large-Conductance Potassium Channels and Contributes to Pain in a Model of Multiple Sclerosis. Yousuf MS, Samtleben S, Lamothe SM, et al. FASEB Journal : Official Publication of the Federation of American Societies for Experimental Biology. 2020;34(9):12577-12598. doi:10.1096/fj.202001163R.
  22. A Systematic Guideline by the ASPN Workgroup on the Evidence, Education, and Treatment Algorithm for Painful Diabetic Neuropathy: SWEET. Sayed D, Deer TR, Hagedorn JM, et al. Journal of Pain Research. 2024;17:1461-1501. doi:10.2147/JPR.S451006.
  23. Omega-3-Enriched Fish Oil Reduces the Chemotherapy-Induced Peripheral Neuropathy in Mice. Melato J, Goldoni FC, Benvenutti L, et al. Neuropharmacology. 2025;271:110384. doi:10.1016/j.neuropharm.2025.110384.
  24. Docosahexaenoic Acid Improved Vincristine-Induced Peripheral Neuropathy in a Rat Model. Chang CY, Wu CC, Pan PH, et al. Archives of Biochemistry and Biophysics. 2025;:110664. doi:10.1016/j.abb.2025.110664.
  25. Natural Products and Complementary Therapies for Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review. Brami C, Bao T, Deng G. Critical Reviews in Oncology/Hematology. 2016;98:325-34. doi:10.1016/j.critrevonc.2015.11.014.
  26. Integrative Approaches to Chemotherapy-Induced Peripheral Neuropathy. Samuels N, Ben-Arye E. Current Oncology Reports. 2020;22(3):23. doi:10.1007/s11912-020-0891-2.
  27. Antineuropathic Profile of N-Palmitoylethanolamine in a Rat Model of Oxaliplatin-Induced Neurotoxicity. Di Cesare Mannelli L, Pacini A, Corti F, et al. PloS One. 2015;10(6):e0128080. doi:10.1371/journal.pone.0128080.
  28. Palmitoylethanolamide Reverses Paclitaxel-Induced Allodynia in Mice. Donvito G, Wilkerson JL, Damaj MI, Lichtman AH. The Journal of Pharmacology and Experimental Therapeutics. 2016;359(2):310-318. doi:10.1124/jpet.116.236182.
  29. The Beneficial Effects of Ultramicronized Palmitoylethanolamide in the Management of Neuropathic Pain and Associated Mood Disorders Induced by Paclitaxel in Mice. Cristiano C, Avagliano C, Cuozzo M, et al. Biomolecules. 2022;12(8):1155. doi:10.3390/biom12081155.
  30. Palmitoylethanolamide Mitigates Paclitaxel Toxicity in Primary Dorsal Root Ganglion Neurons. Elfarnawany A, Dehghani F. Biomolecules. 2022;12(12):1873. doi:10.3390/biom12121873.
  31. Meta-Analysis of Palmitoylethanolamide in Pain Management: Addressing Literature Gaps and Enhancing Understanding. Viña I, López-Moreno M. Nutrition Reviews. 2025;83(7):e1604-e1618. doi:10.1093/nutrit/nuae203.
  32. Palmitoylethanolamide Restores Myelinated-Fibre Function in Patients With Chemotherapy-Induced Painful Neuropathy. Truini A, Biasiotta A, Di Stefano G, et al. CNS & Neurological Disorders Drug Targets. 2011;10(8):916-20. doi:10.2174/187152711799219307.
  33. Melatonin Mitigates Vincristine-Induced Peripheral Neuropathy by Inhibiting TNF-α/astrocytes/microglial Cells Activation in the Spinal Cord of Rats, While Preserving Vincristine’s Chemotherapeutic Efficacy in Lymphoma Cells. El-Sawaf ES, El Maraghy NN, El-Abhar HS, et al. Toxicology and Applied Pharmacology. 2024;492:117134. doi:10.1016/j.taap.2024.117134.
  34. Study of the Possible Synergistic Protective Effects of Melatonin and Pregabalin in Vincristine Induced Peripheral Neuropathy Wistar Albino Rats. Soliman A, Wahid A, Wahby MM, Bassiouny A. Life Sciences. 2020;244:117095. doi:10.1016/j.lfs.2019.117095.
  35. Melatonin Limits Paclitaxel-Induced Mitochondrial Dysfunction in Vitro and Protects Against Paclitaxel-Induced Neuropathic Pain in the Rat. Galley HF, McCormick B, Wilson KL, et al. Journal of Pineal Research. 2017;63(4). doi:10.1111/jpi.12444.
  36. Melatonin Prevents Mitochondrial Dysfunction and Promotes Neuroprotection by Inducing Autophagy During Oxaliplatin-Evoked Peripheral Neuropathy. Areti A, Komirishetty P, Akuthota M, Malik RA, Kumar A. Journal of Pineal Research. 2017;62(3). doi:10.1111/jpi.12393.
  37. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-Asco Guideline. Mao JJ, Ismaila N, Bao T, et al. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2022;40(34):3998-4024. doi:10.1200/JCO.22.01357.
  38. Treatment of Established Chemotherapy-Induced Neuropathy With N-Palmitoylethanolamide: A Randomized, Double-Blind Phase II Pilot Study. Davis MP, Ulrich A, Segal R, et al. Cancers. 2024;16(24):4244. doi:10.3390/cancers16244244.
  39. A Narrative Review of Complementary Nutritional Supplements for Chemotherapy-Induced Peripheral Neuropathy. Liu YW, Liu CT, Su YL, Tsai MY. Alternative Therapies in Health and Medicine. 2020;26(4):43-49.
  40. Phase III Randomized, Placebo-Controlled, Double-Blind Study of Intravenous Calcium and Magnesium to Prevent Oxaliplatin-Induced Sensory Neurotoxicity (N08cb/Alliance). Loprinzi CL, Qin R, Dakhil SR, et al. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2014;32(10):997-1005. doi:10.1200/JCO.2013.52.0536.
  41. Anti-Oxidative Stress Therapies Prevent Severe Chemotherapy-Induced Peripheral Neuropathy in Colorectal Cancer Patients Treated With Oxaliplatin: A Systematic Review and Meta-Analysis. Salama M, Barnes D, Georghiou A, et al. Frontiers in Oncology. 2025;15:1642552. doi:10.3389/fonc.2025.1642552.
  42. The Role of Diet and Non-Pharmacologic Supplements in the Treatment of Chronic Neuropathic Pain: A Systematic Review. Frediani JK, Lal AA, Kim E, et al. Pain Practice : The Official Journal of World Institute of Pain. 2024;24(1):186-210. doi:10.1111/papr.13291.
  43. Chemotherapy-Induced Peripheral Neuropathy in Patients With Breast Cancer Treated With Taxanes (Review). Godiveau M, Jahanmohan JP, Abrial C, Durando X. Oncology Letters. 2025;30(5):508. doi:10.3892/ol.2025.15254.
  44. Traditional Herbal Medicine for the Prevention of Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis With Association Rule Analysis. Kim EH, Jin H, Lee SH, Yoon SW. Frontiers in Pharmacology. 2025;16:1607181. doi:10.3389/fphar.2025.1607181.
  45. Safety and efficacy of cannabidiol in the management of chemotherapy-induced peripheral neuropathy. Weiss M, Giaddui M, Kjelstrom S, et al. Journal of Clinical Oncology. 2023;41(Suppl 16):12020. doi:10.1200/JCO.2023.41.16_suppl.12020.
  46. Recent Developments of Novel Pharmacologic Therapeutics for Prevention of Chemotherapy-Induced Peripheral Neuropathy. Hu S, Huang KM, Adams EJ, Loprinzi CL, Lustberg MB. Clinical Cancer Research : An Official Journal of the American Association for Cancer Research. 2019;25(21):6295-6301. doi:10.1158/1078-0432.CCR-18-2152.
  47. The Effect of Prophylactic Calcium and Magnesium Infusions on the Incidence of Neurotoxicity and Clinical Outcome of Oxaliplatin-Based Systemic Treatment in Advanced Colorectal Cancer Patients. Knijn N, Tol J, Koopman M, et al. European Journal of Cancer (Oxford, England : 1990). 2011;47(3):369-74. doi:10.1016/j.ejca.2010.10.006.

 

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

Supplements recommended by Dr. Ehlenberger may be purchased commercially online

Please read about our statement regarding the sale of products recommended by Dr. Ehlenberger.

 

 

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