Receiving chemotherapy for cancer treatment can lead to a number of unexpected side effects, including damage to the nerves located outside your brain and spinal cord, known as your peripheral nerves. Peripheral neuropathy, which describes nerve damage that’s often felt in your extremities, including your hands, feet, legs and arms, may be caused by a number of factors, from diabetes to alcohol abuse, but it’s also a common side effect of chemotherapy.
“Most cancer chemotherapies can cause peripheral neuropathy,” explains Glynis Vashi, M.D., chief of medicine and lead physician at Cancer Treatment Centers of America® (CTCA) in Suburban Chicago. “Especially the taxanes,” which may include such chemotherapy drugs as paclitaxel (Taxol®), docetaxel (Taxotere®) and cabazitaxel (Jevtana®). Platinum drugs, epothilones, plant alkaloids and thalidomide (Thalomid®) are examples of additional chemotherapy drugs that are frequently linked to peripheral neuropathy, according to the American Cancer Society (ACS).
What Are the Signs and Symptoms of Peripheral Neuropathy?
Pain, burning, numbness and tingling in the areas where your nerves are damaged are the most common symptoms of peripheral neuropathy. The severity varies from person to person, ranging from mild to debilitating.
“It starts out with pain,” Dr. Vashi says. “Your sensory nerves receive all the sensory stimuli, so usually the pain is a burning kind of pain. Then as it gets more severe the pain can ascend more proximally toward the body, and the most severe form is accompanied by muscle weakness.”
So while the pain may initially only be felt in your toes or fingers, it can progress, moving into your feet, ankles and legs or hands and arms. In the most severe cases, you may have severe pain and difficulty walking or carrying out daily activities, such as buttoning a shirt or writing.
Meredith Boudreau, PT, DPT, physical therapist at CTCA® in Suburban Chicago, notes that there are a variety of symptoms that can occur, but many patients describe peripheral neuropathy as a feeling of “walking on gravel” and says sometimes people also have a sensitivity to temperatures, such as cold or heat. “There’s a wide range on severity of symptoms, some people experience only slight numbness while others can barely feel anything, which can lead to trouble with balance,” she says. ACS lists additional symptoms, including:
- Loss of feeling, including less ability to sense pressure, touch and temperatures
- Trouble picking things up or holding things
- Difficulty walking
- Sensitivity to touch or pressure
Less common symptoms may include:
- Shrinking muscles
- Trouble swallowing
- Trouble passing urine
- Changes in blood pressure
- Decreased or no reflexes
Is It Possible to Prevent Peripheral Neuropathy?
Research is ongoing looking into possible tools to prevent chemotherapy-induced peripheral neuropathy (CIPN), but so far results have been mixed. More research is needed, but depending on the type of chemotherapy, the following nutraceuticals have shown some evidence that they could have a protective effect on peripheral neuropathy:
- Vitamin E
- Vitamin B6
- Omega-3 fats
However, according to a review in Critical Reviews in Food Science and Nutrition, “Currently no agent has shown solid beneficial evidence to be recommended for the treatment or prophylaxis of CIPN.” As such, typically when peripheral neuropathy occurs during chemotherapy treatment it’s dealt with by altering the treatment.
“Most oncologists, if the neuropathy seems to be getting more debilitating, would decrease the dose of chemotherapy or stop the therapy,” Dr. Vashi says. Sometimes the chemotherapy would then be restarted once the neuropathy has a chance to subside. Because peripheral neuropathy can also be caused by factors other than cancer treatment, it’s important to address these as well. Dr. Vashi adds:
“We don’t see the patients until they’re having chemotherapy and develop the neuropathy, but in general practice we would want to make sure patients deal with other causes of neuropathy such as poor dietary choices, abusing alcohol, diabetes or the use of certain medications. All of these can cause or add to neuropathy even before the cancer treatment. That way we can help them to start at a better place.”
Treatment Options for Peripheral Neuropathy
Treatments depend on your particular symptoms and their severity. In the mild forms, you can use over-the-counter medications for pain relief. If the pain is severe, prescription pain relievers are the next step. From there, there are specific medications available to treat neuropathy, such as gabapentin (Neurontin®) and antidepressants may also be offered.
“Antidepressants may help increase a patient’s tolerance to pain,” Dr. Vashi says. “When patients are depressed, their pain tolerance is decreased and symptoms are exaggerated.” She also notes that vitamins and nutritional supplements, including vitamin B12 and folate, can be helpful, and for patients who are having trouble walking, physical therapy is recommended.
“If the patient cannot walk and it’s accompanied by muscle weakness, we use physical therapy to help. To help people walk, you can also use specialized footwear,” she says. Boudreau, the physical therapist, often works with patients on balance exercises and grip-strengthening activities, while doing sensory exercises to help patients learn to live with the condition.
Topical neuropathy creams are also available, which may work by temporarily numbing the pain, and there’s also an electrical stimulation unit that helps recreate normal nerve signaling. “It won’t cure the condition,” Boudreau says, “but patients have expressed reduced pain and symptoms with use of electric stimulation.” The prescription-based device is designed to be used at home two to three times a day and can also be administered by a physical therapist. Some people also find relief using acupuncture and essential oils, including aromatherapy massage.
Learning to Live With Peripheral Neuropathy
For some, peripheral neuropathy resolves once chemotherapy is complete. For others, symptoms may persist for years after. “As long as the treatment is ongoing, the neuropathy will be there,” Dr. Vashi says, which is why taking steps to live safely with the condition is so important. “Some people can’t feel the ground, which can result in falls, so education helps patients to know what to expect from having it.”
Boudreau also recommends taking precautions, especially with numbness and pain. “Get your skin checked often and wear proper footwear,” such as closed-toe shoes, to avoid injuries, she says. You may also want to wear gloves to protect your hands and take extra precautions to avoid being harmed by extreme temperatures, such as setting your water heater to a safe temperature to avoid scalding.
If you’re having trouble with muscle weakness, you may need to use the support of a cane or walker, and installing handrails in your home can help you avoid falls. If the symptoms of peripheral neuropathy are persistent and significantly interfering with your quality of life, be sure to let your health care providers know so they can create a treatment plan that addresses your individual needs and provides adequate relief.