Peripheral Neuropathy: What People With Cancer Need to Know

Neuropathy is a general term for a condition that affects the nerves. Peripheral neuropathy refers to any damage affecting the nerves outside of the brain or spinal cord. Neuropathy can feel like numbness, tingling, weakness, burning, or pain. It most often starts in the hands or feet.

Neuropathy is very common in people with cancer. Research shows that 30% to 40% of people with cancer experience some form of neuropathy. 

Neuropathy can be caused by: 

• Chemotherapy
• Damage to nerves caused by surgery to remove a tumor
• Radiation therapy

Neuropathy caused by radiation therapy may not happen for months or even years after treatment is complete.

What causes neuropathy when you have cancer?

Most often, neuropathy is caused by cancer treatment. It can also be caused by a tumor pressing on nerves.

Causes of neuropathy in people with cancer include:

Chemotherapy-induced peripheral neuropathy (CIPN). Neuropathy in people with cancer is most often caused by chemotherapy. Chemotherapy is a medication that destroys cancer cells. It can also damage healthy cells. 

Chemotherapy can cause damage to nerve fibers. This causes pain, numbness, tingling, and weakness. Chemotherapy-induced peripheral neuropathy is one of the most common side effects of chemotherapy. Between 19% to 85% of people treated with these medications develop some amount of neuropathy. 

Common medications that can cause chemotherapy-induced peripheral neuropathy include: 

• Platinum-based drugs: Cisplatin, oxaliplatin, and carboplatin are used to treat many different solid tumors. These medications bind to DNA and affect neurons. 
• Taxanes: Paclitaxel (Taxol) and docetaxel (Taxotere) stop cancer cell growth. They are strong chemotherapy drugs that damage nerve fibers.
• Vinca alkaloids: Vincristine, vinblastine, and vinorelbine stop cell growth by binding to tubulin. They are often used to treat leukemias, lymphomas, and some solid tumors. 

Neuropathy induced by other medications. There are other cancer treatments that can cause neuropathy. These include:

• Proteasome inhibitors: Bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro) are targeted therapies. They prevent the breakdown of damaged protein in cells.
• Other medications: Thalidomide, lenalidomide, and ixabepilone are examples of other medications used during cancer treatment that can cause neuropathy.

Surgery. Sometimes, surgery to remove a tumor can cause damage to healthy nerves. This can cause numbness, tingling, and pain. 

Compression or tumor-related neuropathy. This is nerve damage caused by a tumor pressing on or stretching nerves or restricting blood supply. It can cause pain, numbness, tingling, and weakness, often in the area where the tumor is growing. 

Other conditions. Other conditions can cause neuropathy when you have cancer. Having another condition at the same time as cancer is called a comorbidity or a coexisting condition. Diabetes is one of the most common causes of neuropathy.

Other causes include:

• Infections, including shingles, Lyme disease, hepatitis B and C, and viral or bacterial infections
• Autoimmune diseases such as Sjogren's syndrome, lupus, rheumatoid arthritis, and more
• Other diseases, such as kidney disease or liver disease
• Injuries
• Alcohol use disorder
• Exposures to toxic chemicals
• Low vitamin levels

What are the different types of neuropathy?

There are several different types of neuropathy. These include: 

Sensory neuropathy. This is a type of peripheral nerve damage. It causes abnormal sensations, such as numbness, "pins and needles" pain, burning, and/or the inability to feel hot or cold. It can also cause loss of feeling. It usually begins in the hands and feet. It happens when the nerves that carry touch, temperature, and pain signals are damaged. 

Motor neuropathy. This is a rare form of neuropathy. It gets worse slowly over time. It also causes asymmetrical weakness. Asymmetrical means it affects the nerves on one side of the body more than the other. It most often happens in the hands, arms, and sometimes legs. Weakness usually starts in one hand or forearm. This makes daily tasks, like buttoning a shirt, more difficult. The symptoms can take months or years to get worse.

Autonomic neuropathy. This happens when cancer or its treatment damages nerves that control automatic body functions. These are things your body does without you thinking about it. It includes heart rate, blood pressure, digestion, and bladder control. Symptoms include lightheadedness when you stand up, digestive issues, fainting, nausea, constipation, and abnormal sweating.

What are the treatment options for neuropathy caused by cancer?

Neuropathy can be very disruptive, painful, and uncomfortable. For some people, it is an annoying part of cancer treatment. For others, it can be severe, affecting their daily life. It is important to talk to your care team about any neuropathy that you experience. They can help you find ways to manage your discomfort and pain.

At this time, there is no cure for cancer-related neuropathy. But there are medications and lifestyle changes you can make to help you feel better. These treatments focus on managing symptoms and improving your quality of life. 

If your symptoms are severe, your care team may recommend changing your chemotherapy dose, increasing the time between treatments, or switching to a different medication. 

Medications used to treat neuropathy

Duloxetine (Cymbalta). This is an antidepressant. Research has shown that it can be used to treat chemotherapy-induced peripheral neuropathy. 

Gabapentin and pregabalin. These are medications used to treat neuropathy caused by many different conditions, including shingles, fibromyalgia, and diabetes. They can also be used to help neuropathy caused by cancer or cancer treatment.

Topical creams. Creams containing capsaicin, baclofen, or amitrityline can help ease neuropathy symptoms. 

Other medications. Tricyclic antidepressants are medications used to treat depression. Anticonvulsants are medications used to treat seizures. These may also be used to improve neuropathy symptoms. In some cases, pain specialists may use nerve-blocking techniques or opioids, too. 

Supportive care for neuropathy

Acupuncture or electroacupuncture. Acupuncture is a Traditional Chinese Medicine (TCM) technique that uses needles to stimulate the nervous system. Electroacupuncture adds electricity to the needles to enhance this technique. Both are clinically shown to improve nerve pain and neuropathy symptoms for people with cancer. 

Physical or occupational therapy. Physical therapy helps restore physical activity. A physical therapist uses exercise, massage, hot/cold therapy, and more to help you feel better. Occupational therapy focuses on helping you regain physical function to perform daily living tasks. 

Exercise. Low-impact exercise, like walking, biking, or swimming, can help. 

TENS machines. Transcutaneous electrical nerve stimulation (TENS) uses low-voltage currents to help manage pain. 

Other options. Massage and mind-body techniques like meditation and guided imagery can help reduce stress and manage pain. 

How to manage your neuropathy daily

Depending on how severe your neuropathy is, there are some things that you may want to do every day to monitor your health. This focuses on daily foot inspections, gentle exercise, and skin care. If you are diabetic, you should follow a daily routine of managing your blood sugar levels, wearing protective footwear, and using topical creams to manage neuropathy symptoms.

If you have neuropathy, you should: 

• Check your feet every day for any cuts, blisters, or bruises. This will help you avoid infections.
• Wear comfortable, supportive shoes with socks at all times to protect your feet.
• Daily movement, such as walking, improves blood flow.
• Warm baths, gentle massage, and Epsom salt soaks can help ease painful limbs. 
• Neuropathy can make you unsteady on your feet. Remove tripping hazards, add railings to tubs, and use walking aids if you need them. 
• Avoid smoking or drinking too much alcohol to prevent more nerve damage.
• Roll feet over a tennis ball to help aid in blood circulation.

Always remember to talk to your care team to help you manage your neuropathy symptoms. They can support you and find ways to improve your quality of life.

Questions to ask your care team about neuropathy

Neuropathy can begin at any time during chemotherapy. It is important to report your symptoms early to your care team.

You may want to ask if your treatment center provides pain specialists, physical therapists, and supportive care. Your comfort, safety, and quality of life are very important. 

Consider asking your care team these questions about neuropathy: 

• Are these symptoms normal for the type of chemotherapy I am getting?
• Is there anything I can do to ease the discomfort or protect my nerves?
• Are there any medications or therapies that could help?
• Will neuropathy go away after treatment ends, or could it be long-term?
• Should we consider adjusting my chemotherapy plan?
• Are there signs I should watch for that mean I need to call right away?

Track your symptoms with HealthTree

HealthTree Foundation offers an easy way to track your symptoms and share that information with your care team. You can also find out how other people with cancer have managed their side effects. 

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Sources: 

Neuropathy Fact Sheet: Yale Medicine

Peripheral Neuropathy: Mayo Clinic

Peripheral Neuropathy and Chemotherapy: MD Anderson

Mechanisms of Chemotherapy-Induced Peripheral Neuropathy: International Journal of Molecular Sciences

Exploring Chemotherapy-Induced Peripheral Neuropathy Management Practice Patterns Among Oncology Clinicians: Seminars in Oncology Nursing

Neuropathic cancer pain: prevalence, pathophysiology, and management: Korean Journal of Internal Medicine

Chemotherapy-Induced Neuropathy: What Patients Need to Know: OncoDaily