Managing Chemotherapy-Induced Peripheral Neuropathy
Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology, Social Work
FEBRUARY 01, 2022
Peripheral neuropathy refers to symptoms, including pain, tingling, burning, numbness, sensitivity to hot and cold, and difficulty in using fine motor skills for basic tasks like fastening buttons or picking up a coffee cup, that happen after damage to peripheral nerves. These are our nerves that carry sensation and control movement to our arms, hands, legs, and feet. Sometimes chemotherapy drugs can cause peripheral neuropathy; this is called chemotherapy-induced peripheral neuropathy (CIPN).
There are strategies to manage any symptoms and, hopefully, improve your situation.
Not all chemotherapy drugs carry this risk, and not everyone who is treated with those that do goes on to experience CIPN. Indeed, patients in treatment are carefully questioned about any CIPN symptoms at each visit, and sometimes the decision is made to reduce the dosage or stop treatment sooner than initially planned. The drugs that are most common culprits include platinum drugs (such as oxaliplatin or cisplatin), taxanes (such as docetaxel), vinca alkaloids (such as vincristine), and some drugs used in the treatment of multiple myeloma. Any one person’s risk of developing CIPN is increased with higher doses and multiple treatment cycles. Some people, including those who are older or have diabetes or certain vitamin deficiencies, are at higher risk.
It is important to note that the intensity and difficulty of CIPN is highly variable. Some people experience mild tingling or pins and needles sensations in their fingers or toes that last for a few days after a chemo treatment. At the other end of the spectrum, some people have pain and discomfort that affects their quality of life and persists for months or even years. A 2014 study found that 30% of people who had CIPN continued to have symptoms six months after completing therapy.
There is no medication or supplement that has been proven to be effective at preventing CIPN. For most of us, it is another one of the unpleasant risks of cancer treatment that is outweighed by the need for chemotherapy. Once again, we accept possible short- or long-term risks in the service of effectively treating our cancer. If CIPN pain is severe, there are a number of drugs that can help. These include a short course of steroids until another plan is developed, very small doses of antidepressant or anti-seizure medicines, and topical creams or patches of numbing agents (like lidocaine). If pain is very severe, pain medications, including opioids, may be prescribed.
Anyone being treated for cancer is likely to already be taking a number of medicines. It can seem that we have our own personal pharmacies on our kitchen counters. Many of us are loathe to add more medicines to those that we must take and would prefer to try other kinds of treatment. Fortunately, there are a number of non-pharmaceutical approaches that can help: physical therapy or occupational therapy, meditation and relaxation, acupuncture, and biofeedback.
In my clinical experience, I have known many women who had some degree of CIPN and found acupuncture to be extremely helpful. Their advice has consistently been to start acupuncture treatments at the first sign of trouble, not to wait until the CIPN is better established and more problematic. It is also clear that acupuncture needs to be ongoing, for the duration of the chemotherapy treatment and perhaps a while afterwards, and at least once/week. Since not all medical insurances cover the cost of acupuncture, this can be a problem. Ask your providers if the treatment is available at your treatment center and ask in the community. It is likely that you know people who have used acupuncture for a range of issues, and they may be able to refer you to a practitioner nearby whose rates are reasonable.
There are strategies to manage any symptoms and, hopefully, improve your situation. If pain medicine has been prescribed, take it as suggested. Sometimes we wait and hope the pain will diminish, and then we are behind it. It works best if taken before the pain gets bad. If the neuropathy is in your feet, try different shoes to learn what works best. Many of my patients have been most comfortable, although maybe less fashionable, in sneakers or Crocs; socks usually help. It also helps to sit as much as possible, taking the weight off your legs and feet. Try to sit on a stool at the kitchen counter while you work or even while you wash your face and brush your teeth. Allow yourself extra time for any tasks. Finally, reduce or stop drinking any alcohol; there is some evidence that it may exacerbate neuropathy.
Although there are a few people whose neuropathy lasts for a very long time, most have a shorter experience. Believe that you are very likely to be luckier.