The Power of Movement. How Exercise Influences Chemotherapy-Induced Peripheral Neuropathy

Abstract

As the number of cancer patients and survivors increases, we face a rising challenge: the long-term impact of treatment's adverse effects. One of the known adverse effects is chemotherapy-induced peripheral neuropathy (CIPN), that courses with neuropathic pain. The treatments of CIPN have reduced efficacy. The neurobiological causes of CIPN have been mainly ascribed to peripheral nerve damage but recent studies show effects in the brain, namely at the descending pain modulatory systems. Physical exercise seems to be associated with better outcomes in CIPN patients but the mechanisms underlying the effects were not discussed, namely taking into account the recent results of the effects of CIPN in brain structures involved in pain modulation. In this critical review we propose that the beneficial effects of exercise in CIPN have also central causes, due to mechanisms that act on neuroinflammation and oxidative stress, and also with the involvement of neurotrophic factors, with a direct effect in optimizing the endogenous pain modulation, namely at opiods, monoamines, and endocannabinoids. The effects are multifactorial as mood improvement and other psychological benefits of exercise should be considered. This review critically synthesizes the available literature to highlight how the pain-modulating effects of exercise make it a promising strategy for managing CIPN, both in preventive and treatment perspectives.