A 73-year-old woman who presented with postmenopausal bleeding for 20 years was admitted to the gynecology department at the Third Affiliated Hospital of Sun Yat-Sen University. Her past medical history revealed type 2 diabetes mellitus with regular hypoglycemic drugs. On admission, the test of serum tumor markers showed that carbohydrate antigen-125 was 90.4 U/ml, carbohydrate antigen-199 was 41.6 U/ml, and human epididymal protein 4 was 153 mmol/L. Considering the results of the pathological morphology examination (Figure 1) comprehensively, she was diagnosed with endometrial carcinoma. On the 10th day after admission, the gynecologist performed a hysterectomy plus lymph node dissection for her. After 1 week of surgery, she accepted chemotherapy (docetaxel 100 mg, carboplatin 500 mg, 1 day) and was discharged. The pelvic magnetic resonance imaging (Figure 2) at 1 month after surgery showed no residual tumor tissue, or metastasis was detected. Hence, she started to accept radiotherapy (IMRT PTV:50Gy/2Gy/25F). Approximately 3 months after surgery, she was back to the hospital because of the burning, electric shock-like pain, and pitting edema of the left lower limb that got an outbreak. Other complaints included constipation, frequent micturition, and insomnia. Neoplasm metastasis, recurrence, and deep venous thrombosis were excluded through a series of examinations like pelvic imaging and ultrasonic testing (Figure 3). She accepted oral pain relief drugs (pregabalin 75 mg Bid and mecobalamin 0.5 mg Tid) for 2 weeks but her symptoms did not improve. Therefore, she sought the aid of acupuncture in the outpatient department ~4 months after surgery. Physical examination showed hyperalgesia in the medial side of the lower limb, pressing pain (++) in the left groin area, and weakness of muscle strength of the left lower extremity. The pain intensity score evaluated by the numerical rating scale (NRS) was as high as 7 points. To control the pain better, we applied enhanced acupuncture therapy, accompanied by adjusting the dosage of medication (pregabalin 75 mg 8 am/150 mg 8 pm). The acupuncture treatment procedure was composed of manual acupuncture and electro-acupuncture, which was given 3 times per week, a total of 20 sessions of treatments within 8 weeks and implemented by an experienced and certified acupuncturist who had over 5 years of experience. The details of acupuncture based on the theory of traditional Chinese medicine, such as the acupoints, we chose and needling methods are demonstrated in Supplementary material 1.
After five times of performing therapies, the patient claimed that the pain had relief significantly, and the NRS scores decreased from 7 to 3. Subsequently, accompanied by acupuncture therapy and the improvement of pain, the dose of pregabalin was reduced gradually until it was discontinued (Figure 4). After 20 times of therapy, the patient felt relieved of the pain completely, but the edema of the lower limb was not improved. No side effect or adverse event was observed in association with the treatment methods described. During a telephone follow-up, 6 months after the end of treatment, the patient reported no recurrences of neuropathic pain.