Chemotherapy-induced peripheral neuropathy

Gabriella Kourie explains the symptoms of chemotherapy-induced peripheral neuropathy and how to manage it.

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Chemotherapy-induced peripheral neuropathy (CIPN) is a common and often challenging side effect that you may experience with certain chemotherapy drugs. 

These chemotherapy drugs are predominantly platinum compounds (cisplatin, oxaliplatin), taxanes (paclitaxel, docetaxel), and vinca alkaloids (vincristine). These can affect your peripheral nerves and lead to symptoms, such as tingling, numbness, a burning sensation, and muscle weakness, presenting usually in the hands and feet.

To manage CIPN effectively, you should combine methods of prevention, controlling early symptoms, and using non-pharmaceutical approaches and support.

The symptoms of chemotherapy-induced peripheral neuropathy can vary from patient to patient in terms of severity and duration. In some cases, the side effects can last long after chemotherapy has ended.

Preventative strategies

There are no current proven ways to completely prevent CIPN, however, there are preventative strategies that are known to reduce the burden and/or onset of CIPN.

Cold packs

By using a cold pack or cold gloves and socks, you can constrict the blood vessels in this region and in turn reduce the chemotherapy drug delivery to the extremities. This can potentially decrease the risk of chemotherapy-induced peripheral neuropathy.

Exercise

Regular exercise has numerous benefits and can improve overall health and well-being during chemotherapy. There are ongoing studies aiming to prove the effectiveness of regular exercise reducing the risk of CIPN.

Managing pre-existing conditions

Patients with other comorbidities, such as diabetes or other neurological conditions, increase the risk of chemotherapy-induced peripheral neuropathy and should be managed effectively to reduce the severity. 

Identify early symptoms

The next step to managing CIPN is to be able to identify early symptoms of the condition, notify your treating oncologist about it, and monitor the severity of your symptoms. The signs to look out for are: 

• A tingling or pins and needles sensation in the hands and/or feet.
• Numbness in the hands or feet.
• Sharp and burning pains in the peripheral limbs.
• Difficulty with fine motor skills, such as opening bottles and buttoning a shirt. 
• A decrease in balance and sensation of where your foot is when you walk. 

Early recognition is essential. Since chemotherapy is an accumulative treatment, symptoms can worsen as chemotherapy continues.

Management

The first line of management often involves your oncologist adjusting the chemotherapy dosage or schedule. Your treating oncologist will carefully weigh the benefits of continuing the drugs against the risks of the neuropathy worsening. Your oncologist may prescribe certain oral medications to manage CIPN pain as well as suggest certain vitamin B (B6 and B12) supplements. It’s vital that you do not take any medications and/or supplements without checking with your oncologist first.

Alternative treatments 

Physiotherapy and occupational therapy 

Treatment plans can help to improve your balance, co-ordination, and strength. Occupational therapists offer patients strategies and adaptive tools to use, making daily functions doable. An occupational therapist is further trained to help with nerve desensitisation, helping in cases where patients have burning sensations and pins and needles in their hands and feet.

Exercise 

Aerobic and resistance training may reduce chemotherapy-induced peripheral neuropathy severity and improve your function. Regular movement also supports general circulation and nerve health.

Acupuncture

Based on studies and patient feedback, acupuncture may help relieve neuropathic symptoms in the feet, although evidence is still being obtained.

Put your well-being first 

You need to further manage your well-being by assessing aspects like foot care; inspecting your feet daily for injuries and wearing protective shoes that aid balance and give good proprioceptive feedback when walking. 

Another factor with CIPN is the inability to feel temperatures properly and you need to avoid extreme temperatures of heat and cold.

With all that said, the good news is that there is ongoing research into neuroprotective agents and alternative therapies to prevent and treat CIPN. While there’s currently no definitive cure, a multi-disciplinary approach can greatly improve quality of life for those affected both during and after cancer treatment.