Narrative review of non-pharmacological interventions for chemotherapy-induced peripheral neuropathy: exercise, physical therapy, cryotherapy and acupuncture

Purpose Chemotherapy-induced peripheral neuropathy (CIPN) is a heterogeneous, treatment-limiting adverse event of cytotoxic chemotherapy that impairs sensory, motor, autonomic and balance function, and substantially reduces cancer patients’ quality of life. Current pharmacotherapy options are limited: duloxetine is the only guideline-recommended agent for established painful CIPN, while no drugs are approved for primary prevention. Non-pharmacological interventions have emerged as promising adjunctive strategies, yet evidence strength varies widely across modalities and patient subgroups. This narrative review aimed to synthesize contemporary clinical evidence of non-pharmacological interventions for CIPN prevention, symptom treatment and functional rehabilitation, to deliver stratified, chemotherapy-specific clinical guidance and identify gaps for future research. Method A narrative review design was adopted, without pre-registration or standardized systematic review screening protocols. Targeted manual literature retrieval was conducted across PubMed, Web of Science, CNKI and Wanfang Data for peer-reviewed human clinical studies published between January 2018 and March 2025. We focused on four core non-pharmacological modalities for CIPN: multimodal exercise therapy, physical therapy incorporating cryotherapy, acupuncture-based complementary therapies, and behavioral self-management interventions. High-certainty evidence was defined as consistent results from large multicenter randomized controlled trials and network meta-analyses; moderate/low-certainty evidence was derived from small single-center trials and observational studies. Results Cumulative stratified evidence demonstrates clear heterogeneity in intervention efficacy and clinical applicability. Multimodal supervised exercise and physical rehabilitation carry the most consistent high-certainty evidence for both primary CIPN prevention and functional recovery, with significant improvements in numbness, neuropathic pain, balance and muscle strength. Cryotherapy shows robust preventive efficacy exclusively in patients receiving taxane chemotherapy, with insufficient supportive data for platinum or vinca alkaloid regimens. Acupuncture, including warm needle acupuncture, TEAS and electroacupuncture, provides moderate-to-low certainty adjunctive relief for refractory established CIPN symptoms but is not recommended as first-line therapy. Behavioral interventions exert limited direct therapeutic effects on nerve injury, yet effectively improve symptom coping, treatment adherence and long-term self-management. All interventions exhibit favorable safety profiles with minimal severe adverse events when individualized to patient fitness, comorbidities and chemotherapy regimens. Conclusion Non-pharmacological interventions cannot be considered uniformly effective for all CIPN populations; evidence strength and clinical indications differ markedly by modality. Supervised multimodal exercise and physical rehabilitation represent first-line adjunctive strategies for broad CIPN prevention and functional recovery. Cryotherapy is a targeted preventive option limited to taxane-treated patients. Acupuncture serves as secondary adjunctive care for persistent symptoms, while behavioral interventions function as supportive self-management tools. Clinical implementation requires agent-specific patient stratification, individualized intervention prescription, standardized validated CIPN assessment tools, and integrated multidisciplinary oncology rehabilitation pathways. Further large, stratified randomized controlled trials with long-term follow-up are required to standardize intervention protocols and validate sustained clinical benefits.