Numbness, Tingling, & Pain
Chemotherapy-induced neuropathy is defined as numbness, tingling, and/or pain in the limbs that occurs because of chemotherapy. It is thought to be caused by damage to the peripheral nerves, which are the nerves outside the brain and spinal cord. It can lead to problems with walking, balance, and fine motor function. It is typically in a stocking-glove distribution (feet/hands) but can affect entire limbs. The biggest concern is related to falls and injuries. However, it can also impact quality of life and affect both work and play.
What Causes It?
The most common chemotherapies that have been attributed to chemotherapy-induced peripheral neuropathy include taxanes (paclitaxel and docetaxel) , platinum- drugs (cisplatin and carboplatin), plant alkaloids (vinblastine, vincristine, and etoposide), immunomodulating drugs (thalidomide), and proteasome inhibitors (bortezomib (Velcade)).
Unfortunately, we currently do not have any way to prevent chemotherapy-induced neuropathy. We also cannot predict who will experience it and who will not. Oncologists can help reduce neuropathy by decreasing doses or delaying treatment when neuropathy occurs during treatment. Neuropathy may improve after treatment is completed, but it can also be permeant.
Treatment
Currently, the only treatment that is recommended by the American Society of Clinic Oncology (ASCO, 2020) is duloxetine. Duloxetine is a prescription medication commonly used to treat depression. Other medications that can be considered include tricyclic antidepressants and gabapentin. Gabapentin is an anti-seizure medication that is typically used for peripheral neuropathy caused by other reasons such as diabetes. Some other therapies that have shown some benefit include physical or occupational therapy, acupuncture, relaxation therapy, and guided imagery. It is always important to discuss any treatments that you are considering with your healthcare provider prior to starting to make sure they are safe for you.
Peripheral neuropathy can be very difficult to treat, but there are things that you can do to help your symptoms.
- Avoids things that make your symptoms worse, such as hot/cold temperatures.
- Give yourself extra time to do things. Ask friends/family for help to complete tasks.
- Don’t drink alcohol. It can cause additional nerve damage and make neuropathy worse.
- If you have diabetes, control your blood sugars. Having high blood sugars can also cause additional nerve damage.
- If approved by your healthcare provider, exercise. Seek out guidance from a professional, who can help guide what exercises may work best for you.
- Eat a healthy diet with plenty of fruits, vegetables, and whole grains. Also make sure you are staying well hydrated with water.
(Adapted from: American Cancer Society website, 2021)
There are also ways to help prevent injury or accidents because of neuropathy:
- If the neuropathy is in your hands make sure that you are very careful with any knives, scissors, or other sharp objects. Consider using gloves whenever cleaning or working outside.
- If the neuropathy is in your feet make sure that you are wearing shoes that cover the entire foot and that they give good support. Take care of your feet and make sure that you inspect them daily for any sores or wounds.
- If you have problems with balance or walking, make sure that you have support devices in place to assist you. This may include handrails, cane, or walker.
- Use nightlights or flashlights when getting up in the night/dark.
- Protect yourself from extreme temperatures. Set water heaters between 105F and 120F to prevent scalding. Use oven mitts or hot pads when cooking. Use gloves and stockings to stay warm in the cold temperatures.
(Adapted from: American Cancer Society website, 2021)
The Nassif Community Cancer Center is here to help with your cancer related peripheral neuropathy concerns. We have an exercise specialist for one-on-one exercise and dietitians available to help with any diet concerns. The Cancer Center also offers reduced-cost massage, Healing Energy therapy, and acupuncture.
If you would like to schedule an appointment for any of these services or would like further information, please call 319-558-4876. You can also get more information by visiting our website at www.communitycancercenter.org
References
American Cancer Society, 2021. Peripheral Neuropathy. Available at: Peripheral Neuropathy (cancer.org) Last accessed on August 13, 2021.
American Society of Clinical Oncology, 2020. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Adult Cancer Survivors. DOI: 10.1200/JCO.20.01399 Last accessed on August 13, 2021.
