Chemotherapy can be a lifesaving treatment for cancer, but it often comes with side effects. One common issue I see in the clinic all the time is chemotherapy-induced peripheral neuropathy (CIPN), which causes nerve damage in the hands and feet. This can lead to pain, numbness, and tingling that may last for months or even years after treatment ends.
CIPN is debilitating but you absolutely can take steps to improve your symptoms and reduce its impact on your daily life. While there’s no guaranteed cure, many of my patients find relief through a mix of medical treatments and lifestyle changes.
Obviously, talk to your doctor about any symptoms you’re experiencing. They can help you create a plan to manage neuropathy and suggest treatments that may work best for your situation.
However, as the captain of your ship, understanding CIPN is the first step in finding ways to cope. With the right approach, you can minimize the effects of CIPN and look forward to a better, symptom-free life.
Understanding Chemotherapy-Induced Peripheral Neuropathy
Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment. It can cause nerve damage and lead to various symptoms that affect your daily life.
How Does Chemotherapy-Induced Peripheral Neuropathy Occur?
CIPN happens when chemotherapy drugs harm your nerves. These drugs can damage the structure of nerve cells and disrupt how they work. The damage often occurs in the longest nerves in your body, which go to your hands and feet. That’s why CIPN always occurs in the hands and feet first.
Fortunately, most doctors look out for this red flag and take steps to limit CIPN before it starts to affect other nerves in the body.
CIPN is complex with many contributing factors including:
- Mitochondrial dysfunction
- Oxidative stress
- Ion channel impairment
- Neuroinflammation
- Microtubule disruption
- Axon degeneration
I won’t go into the pathophysiology of CIPN but if you’re interested, you can take a deep dive in this article.
Risk Factors and Neurotoxic Chemotherapy Agents
Some people go through chemotherapy with narry a tingle in sight while others develop numbness after one cycle. Why is this so? And who is at risk? Generally speaking, when you have poor nerve health (either from poor nutrition, smoking, or a disease like diabetes), you’re at higher risk of developing CIPN.
Some factors make you more likely to get CIPN:
- Older age
- Diabetes
- Previous nerve damage
- Smoking
- Peripheral vascular disease (poor blood flow to extremities)
Certain chemotherapy drugs are more likely to cause CIPN:
- Taxanes (e.g., paclitaxel)
- Platinum compounds (e.g., cisplatin)
- Vinca alkaloids (e.g., vincristine)
These drugs can harm your nerves in different ways. Some affect the nerve cell body, while others damage the axon (the long part of the nerve). Higher doses of these drugs or longer treatment time also increases your risk of CIPN.
Symptoms and Impact on Quality of Life
CIPN can cause many symptoms that affect how you feel and what you can do. Common symptoms include:
- Numbness and tingling in hands and feet
- Pain or burning feelings
- Weakness in muscles
- Loss of balance
- Trouble with fine motor skills
These symptoms can make daily tasks hard. You might have trouble buttoning clothes, writing, or walking. This can lower your quality of life.
CIPN can also cause:
- Sleep problems due to pain
- Risk of falls from balance issues
- Anxiety or depression
- Difficulty working or doing hobbies
Unfortunately CIPN tends to worsen over 3-6 weeks even after the cessation of the offending agent. The best way to manage CIPN is to avoid getting it in the first place (in other words, reduce/cease the offending chemo drug before CIPN becomes severe/persistent).
Sadly, this is easier said than done. There is a fine balance between stopping an effective treatment too early and causing permanent nerve damage. Often, both patients and oncologists tend to stop chemo that little bit too late and patients end up with persistent CIPN that can last for many months to years.
Treatment Options and Management of CIPN
The truth is, there are no proven treatment options for treating CIPN. However, in desperation, oncologists and patients alike use the following measures with varying degrees of success.
Pharmacological Interventions
Duloxetine is recommended as a first-line treatment for CIPN pain based on limited evidence. This medication can help reduce nerve pain and improve function. Your doctor may prescribe it if you have moderate to severe CIPN symptoms.
Gabapentin and pregabalin are sometimes used to treat CIPN pain, though evidence for their effectiveness is mixed. These drugs may help reduce nerve pain in some patients.
Amitriptyline, a tricyclic antidepressant, is another option for managing CIPN symptoms. It can help with pain and sleep disturbances related to neuropathy.
For severe pain, your doctor might suggest opioids, but these are typically used cautiously due to side effects and addiction risks.
Non-Pharmacological and Complementary Therapies
Acupuncture may help relieve CIPN symptoms. Some patients report reduced pain and improved sensation after acupuncture treatments. I never recommend acupuncture when patients are immunosuppressed or still undergoing chemo. However, I always recommend acupressure as an alternative
Scrambler therapy is a newer approach that uses electrical stimulation to “re-train” nerves. It shows promise in reducing CIPN pain for some patients. At the time of writing, this treatment is not widely available yet.
Topical treatments like capsaicin cream might provide localized relief for nerve pain in hands and feet.
Supplements such as vitamin B complex, alpha-lipoic acid, and glutamine are being studied for CIPN, but more research is needed to confirm their benefits.
Having said that, B vitamins are widely known to help improve nerve health through various mechanisms. Despite the lack of conclusive evidence, I almost always recommend my patients take a good over-the-counter B complex supplement if they have CIPN.
Make sure that your oncologist checks your B12, folate and iron levels as optimizing these vitamins and minerals in your body will help your nerves recover.
Exercise and Physical Therapy Approaches
Regular exercise can improve strength, balance, and overall function in CIPN patients. Start with gentle activities and gradually increase intensity as tolerated.
Physical therapy can help you maintain mobility and reduce fall risk. A therapist can teach you exercises tailored to your specific needs.
Occupational therapy focuses on improving daily living skills affected by CIPN. This might include using adaptive tools or learning new ways to perform tasks.
Yoga and tai chi combine gentle movement with mindfulness, potentially improving balance and reducing pain in CIPN patients.
Lifestyle Modifications
You can take steps to manage CIPN risk. Eating a healthy diet may help your nerves stay strong. Exercise might also protect nerve function.
Further reading:Â What Foods Improve Chemotherapy-Induced Peripheral Neuropathy?
Keep your hands and feet warm, especially in the winter. If your feet are numb, avoid tight shoes for comfort, and to prevent blisters. Check your feet regularly for sores as you might not feel them. If sores are left to fester, you may be at risk of infection.
Innovative Strategies and Preventative Measures
There are ongoing studies aimed at preventing or reducing nerve damage from chemotherapy.
Clinical Research on Preventing CIPN
Some studies look at ways to prevent chemotherapy-induced peripheral neuropathy (CIPN) and others use drugs that may protect your nerves.
Other research investigates if changing chemo doses can help. The goal is to lower CIPN risk without hurting the effectiveness of cancer treatment. Doctors may suggest breaks or lower doses if you have bad symptoms.
Phytotherapeutic treatments are also being studied. These use plant-based remedies. Some might help protect nerves during chemo.
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