People living with cancer and coping with its treatment may experience nerve symptoms, which they often describe as pain, tingling, burning, or numbness. Some people with cancer also have problems with coordination and balance. All of these symptoms may be caused by peripheral neuropathy (as known as nerve damage). In this condition, nerves outside the brain and spinal cord have been damaged, often by the cancer treatments. Sometimes the symptoms are temporary and gradually decrease after cancer treatments are completed. At other times, the symptoms may persist, requiring ongoing medical attention and care. Sometimes the neuropathy affects only one nerve. At other times, it occurs in several nerves.

Although peripheral neuropathy may be a side effect of cancer treatment, it may also be caused by other conditions not associated with cancer, such as diabetes. That is why it is so important to talk with your health care team when you experience any symptoms. This can help your doctor weigh the likelihood of one versus another as being the reason for the symptoms. For example, coughing and sniffling could be caused by hay fever, the overuse of a nasal decongestant spray, or the common cold. Peripheral neuropathy could be caused by the cancer itself, cancer treatments, or other conditions, as we discuss in the next section. Understanding the cause helps doctors offer the right treatment.

Symptoms of Peripheral Neuropathy

Symptoms depend on which nerve is involved, the cause of the condition, and the length of time the neuropathy has been present. Major symptoms may include any of the following:

  • Weakness
  • Pain
  • Muscle loss
  • Loss of feeling in a particular area
  • Loss of or reduced reflex responses
  • Burning sensation along the route of a nerve in the body
  • Tingling sensation in the hands, feet, or other parts of the body
  • Sharp, shooting pain
  • Hearing loss
  • Problems with balance
  • Difficulty picking up objects

These symptoms can build over time. Some people don’t notice them until they have had several chemotherapy treatments.

Causes of Peripheral Neuropathy

In people with cancer, peripheral neuropathy is usually caused by damage to nerves from surgery, radiation treatment, or chemotherapy. It can also be caused by a tumor pressing on or penetrating a nerve, or an infection that affects the nerves, such as shingles. Excess alcohol use or chronic health problems such as diabetes can cause or contribute to neuropathy as well. Many factors impact the degree to which someone experiences neuropathy including:

  • The type of chemotherapy drug or combination of drugs used
  • The chemotherapy dosage
  • The way the chemotherapy is delivered (i.e. intravenously or subcutaneously)
  • The overall length of the treatment regimen
  • The presence of contributing factors such as diabetes or vitamin deficiencies
  • In addition, each person responds differently to chemotherapy.

It’s important to tell your doctor as soon as possible if you experience these types of side effects, particularly if you are still receiving therapy, as this may affect chemotherapy recommendations. Typically, doctors treating neuropathy aim to reduce pain. Commonly used treatments include:

Antidepressant medications. Antidepressant may help relieve the pain of peripheral neuropathy. Doses prescribed are often smaller than the doses that doctors typically use to treat depression.

Anticonvulsants. Anticonvulsants alone or in combination with antidepressant medications can be helpful in treating neuropathic pain.

Steroid. Steroid medications are sometimes used in the short run to relieve severe neuropathic pain until a better long-term treatment plan is in place.

Patches or creams. Patches or creams can be applied directly to the painful site and can be especially helpful in managing neuropathic pain.

Opioids. Opioids, such as morphine, are often used in combination with other medications to manage severe neuropathic pain.

Physical, occupational, and relaxation therapy, can be effective for neuropathic pain. Strengthening muscles can help improve balance and coordination. In some cases, acupuncture or biofeedback, a technique in which a patient watches measures of his or her own bodily functions (such as heartbeat, blood pressure, and muscle tension), can be helpful.

Vitamins. B vitamins may sometimes be utilized to treat neuropathy, such as vitamin B6. All vitamins should be discussed with your doctor prior to initiating. It is very helpful to work with a pain specialist who can recommend a good treatment plan. This is especially important if your symptoms have not responded to your current treatment. A second opinion is always valuable because it either confirms your doctor’s advice or offers more information.

Symptoms of painful peripheral neuropathy may decrease over time. But it sometimes takes one or two years for the symptoms to go away completely. And some people experience longer-term symptoms. There are a number of things you can do to manage the symptoms of peripheral neuropathy and cope with this condition:

Avoid alcoholic drinks. Even a glass or two of wine or beer can affect your nerves, particularly if the nerves have been exposed to chemotherapy. Stay ahead of your pain. Take pain medication early in the day, before symptoms become severe. The drugs often work much better this way.

Pay attention to your shoes. Neuropathy often causes foot symptoms. If that’s the case, try shoes with “rocker bottoms”—smooth soles that have rockers (much like the bottom of a rocking horse) that allow the foot to roll while walking, taking off some of the pressure. Or, try wearing sneakers and/or using orthotics (customized foot supports) in your shoes. Your physiatrist, physical therapist, or occupational therapist should be able to advise you on where to buy orthotics.

Sit down, when possible, if neuropathy in your feet is severe. Set up areas in your home where you can sit to do activities you normally do standing up, such as shaving, putting on makeup, drying your hair, or chopping vegetables, for example. This can make a tremendous difference in how your feet feel.

Pay extra attention to your feet. At least once a week, use a hand-held mirror to check your feet for sores or open wounds.

Get a wider grip. If your hands feel clumsy or weak, consider buying household tools such as kitchen knives and hammers with a wide grip. This frees the hand from gripping too tightly, which can lead to discomfort. You can also get a non-slip grip for the steering wheel in your car.

Consider using voice-activated computer software if it’s difficult for you to type. There are a number of programs and different kinds of equipment that allow you to use a computer without typing, giving the hands a rest. Newer computers have voice-activated software already built into them. All you may need to add to your computer is an inexpensive microphone.

Ensure your home is as safe as possible: Store cords safely away and remove rugs. Install ramps rather than stairs if possible.

If balance is an issue consider physical therapy evaluation for assistive devices such as canes, walkers with seated benches, or bathing chairs.

As you manage your cancer, it’s important to remember that you are a consumer of health care. The best way to make decisions about health care is to educate yourself about your diagnosis and get to know the members of your health care team, including doctors, nurses, dietitians, social workers and patient navigators.

Here are some tips for improving communication with your health care team:

Start a health care journal. Having a health care journal or notebook will allow you to keep all of your health information in one place. You may want to write down the names and contact information of the members of your health care team, as well as any questions for your doctor. Keep a diary of your daily experiences with symptoms related to your illness or treatment. You can separate your journal or notebook into different sections to help keep it organized.

Prepare a list of questions. Before your next medical appointment, write down your questions and concerns. Because your doctor may have limited time, you should ask your most important questions first, and be as specific and brief as possible. Questions you may want to ask your health care team:

  • What is causing my peripheral neuropathy?
  • What can I do to manage the pain?
  • Is the recommend treatment for my peripheral neuropathy covered by my insurance?
  • Should I avoid certain activities while experiencing symptoms?
  • How long can I expect symptoms to last?

Bring someone with you to your appointments. Even if you have a journal and a prepared list of questions or concerns, it’s always helpful to have support when you go to your appointments. The person who accompanies you can serve as a second set of ears. He or she may also think of questions to ask your doctor or remember details about your symptoms or treatment that you may have forgotten.

Write down your doctor’s answers. Taking notes will help you remember your doctor’s responses, advice, and instructions. If you cannot write down the answers, ask the person who accompanies you to do that for you. If you have a mobile device, ask if you can use it to take notes. Writing notes will help you review the information later.

Record your visit if your doctor allows it. Recording the conversation with your doctor gives you a chance to hear specific information again or share it with family members or friends.

Incorporate other health care professionals into your team. Your medical oncologist is an essential member of your health care team, but there are other health care professionals who can help you manage your diagnosis and treatment:

  • Your primary care physician should be kept updated about your cancer treatment and any test results.
  • Your local pharmacist is a great source of knowledge about the medications you are taking; have all of your prescriptions filled at the same pharmacy to avoid the possibility of harmful drug interactions.
  • Make sure your oncologists know of any other medical conditions you have, or any pain you are experiencing, so that they can consult with your primary care physician or your specialist if needed. Be sure you communicate all therapies you receive, including supplement use and alternative care modalities such as acupuncture, massage, etc.

Remember, there is no such thing as over-communication. Your health care team wants to know about how you’re feeling overall, which includes your level of pain, your energy level, your appetite, and your mood and spirits.

Frequently Asked Questions

Q. Is there anything I can do, such as take a vitamin supplement, to prevent neuropathy?

A. Unfortunately, it’s often difficult to prevent neuropathy caused by cancer or treatments for cancer. Eating a healthful diet is always important. If you do take any supplements, be sure to tell your doctor, as some over-the-counter products may interact with chemotherapy. In addition, while you’re receiving cancer treatment, it’s important to avoid alcohol, which can increase the severity of neuropathy caused by chemotherapy. Most importantly, before starting chemotherapy and during your treatment, tell your doctor or nurse if you experience numbness and tingling in your hands and/or feet so that he or she can adjust your medication.

Q. I finished treatment two years ago with neuropathy. How long does neuropathy usually last? What treatments might I pursue?

A. Many cancer survivors experience post-treatment neuropathy. For some, the symptoms may lessen gradually over a period of weeks or months. For others, the symptoms may persist or even become chronic. It is difficult to provide a typical timeline of symptoms, because there is so much variation from case to case. Many factors impact the degree to which someone experiences neuropathy including:

  • The type of chemotherapy drug or combination of drugs used
  • The chemotherapy dosage
  • The overall length of the treatment regimen

In addition, each person responds differently to chemotherapy. It’s important to seek out a consultation with an experienced neurologist if you are experiencing neuropathy. Fortunately, there are a number of treatments available to help manage the chronic pain and discomfort caused by neuropathy. For mild symptoms, over-the-counter pain relievers like Tylenol or Motrin may be adequate. For more severe symptoms, your doctor may prescribe stronger pain medication; anti-convulsant medication to help calm the nerves and central nervous system; or antidepressants to decrease the chemicals in the brain that transmit pain signals. Physical therapy may improve balance and strength while occupational therapy may improve the fine motor skills used in tasks like writing or buttoning a shirt. Alternative treatments such as biofeedback, acupuncture, or transcutaneous nerve stimulation (TENS) are also available. Your health care team can work with you to determine the best treatment or combination of treatments to address your situation.

Q. Any tips for dealing with neuropathy in cold weather?

A. Some may find neuropathy particularly challenging in the cold weather. Prolonged exposure to the cold causes the body to slow blood circulation to the hands and feet in an effort to preserve the body’s core temperature. The reduced blood flow can intensify neuropathy symptoms and potentially cause further damage to already affected peripheral nerves. This is of special concern to those who experience their neuropathy pain as a numbness or tingling sensation. Their ability to measure the effects of the cold is compromised since they already experience those physical warning signals that would otherwise indicate a need to get to warmer conditions.

It is important to know that some particular types of chemotherapy, such as oxaliplatin, may cause cold induced neuropathy. Discuss specific preventative strategies with your provider if your are receiving one of these agents.

Tips to lessen the pain and lower your risk of further nerve damage:

  • Wear warm, dry clothing in cold weather.
  • Protect your hands and feet by wearing thick socks, thick mittens or gloves.
  • Take intermittent breaks from the cold to reduce your exposure to extreme temperatures.
  • Limit or avoid caffeine before an outing as it can temporarily cause blood vessels to narrow.
  • Do not smoke as cigarette smoke can slow circulation.
  • Limit alcohol use since excessive consumption can lead to vitamin deficiency which can, in turn, damage peripheral nerves.
  • Incorporate exercise into your routine to improve overall circulation.
  • Explore comfort measures like massage or use of flexible splints for support.

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Last updated July 14, 2017

The information presented in this publication is provided for your general information only. It is not intended as medical advice and should not be relied upon as a substitute for consultations with qualified health professionals who are aware of your specific situation. We encourage you to take information and questions back to your individual health care provider as a way of creating a dialogue and partnership about your cancer and your treatment.

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