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Peripheral neuropathy

Peripheral neuropathy occurs when some chemotherapy drugs cause inflammation or injury to your peripheral nerves.

What is peripheral neuropathy?

Peripheral neuropathy occurs when some chemotherapy drugs cause inflammation or injury to your peripheral nerves.

Peripheral nerves include the nerves outside your brain and spinal cord such as nerves of the face, arms, legs and torso. When they are damaged, it can impact sensation, movement and function in these parts of your body – limbs tend to be the most commonly affected.

There can also be other effects throughout the body related to nerve damage.

What causes peripheral neuropathy during cancer treatment?

Peripheral neuropathy is associated with a small number of specific chemotherapy drugs.

The effects are commonly related to the dose administered and cumulative treatments.

What are the signs and symptoms of peripheral neuropathy?

The onset of symptoms can be sudden or progressive and range from mild to severe. Signs and symptoms can include:

Gradual development of symptoms on both sides of the body – Such as abnormal sense of touch, sensations such as burning, wetness, itching, electric shock, and pins and needles in limbs, or pins and needles starting in the fingers and toes and further developing up arms and legs
Weakness and muscle pain in limbs
Reduced awareness of limb positioning and perception of movement
Inability to perform fine motor movement (such as buttoning a shirt or picking up a coin from a flat surface)
Constipation (particularly related to treatment with vinka-alkaloids)
Ringing in the ears and/or difficulty hearing (related to treatment with cisplatin)

How can peripheral neuropathy be prevented/managed?

Your health care team will discuss if you are at risk of peripheral neuropathy before starting treatment. Treatment doses will be carefully monitored to reduce the risk of peripheral neuropathy. If you are having a drug called oxaliplatin you should avoid cold drinks and food before and after each treatment. If you do experience symptoms you should report them to your care team as they may consider modifying the treatment regime (e.g. reducing the dose or temporarily ceasing the treatment) to prevent further progression. Symptoms to report include:

Pins and needles
Numbness, pain and/or increased discomfort with certain sensations (particularly in the arms and legs)
Muscle weakness
Inability to perform normal activities (such as buttoning a shirt or picking up a coin from a flat surface)
Constipation

Symptoms are commonly managed similarly to other types of nerve pain with a combination of non-pharmacological treatments (e.g. massage) and medications (e.g. pain medication and antidepressants).

If you do experience any symptoms of peripheral neuropathy, it’s important to consider the below to ensure your safety:

Taking care when mobilising and reduce your risk of falls – Such as keeping room well lit, removing or securing rugs and avoiding slippery, wet floors
Avoiding burns – Consider adjusting hot water temperature, testing bath water with elbow and using oven mitts and pot holders in kitchen
Avoiding trauma – It’s important to keep feet uncovered in bed, avoid tight fitting shoes, wear roomy cotton socks, take care cutting food and opening jars, wear boots and gloves when working in the garden, wear gloves and warm socks in cold weather and avoid excessive alcohol consumption

You may also be referred to a physiotherapist or occupational therapist.

Every patient is different, please discuss your own personal situation with your treating doctor.

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