Neuropathy and Chemotherapy: What You Can Do

Neuropathy is the medical term for nerve damage, usually to the peripheral nerves in the hands, feet, arms, and legs. Chemotherapy drugs are toxic to healthy nerve cells as well as to cancer cells. When those nerves begin to stop working, the result is tingling, numbness, weakness, and pain, even an impaired sense of touch.

Loss of feeling in the hands and feet can make it hard to pick up small objects and cause clumsiness and difficulty walking. Some people with nerve damage first notice a "pins and needles" feeling, not unlike when an arm or leg falls asleep. This same nerve damage can also cause constipation and bladder problems.

Common chemotherapy drugs such as cisplatinum (Platinol), carboplatin (Paraplatin), vincristine (Oncovin), and paclitaxel (Taxol) can strip the coatings from the nerves, particularly those in the hands, feet, arms, and legs. The higher or more frequent the dose of the chemotherapy drug, the greater chance it will cause neuropathy.

Radiation treatment can also lead to neuropathy, and conditions such as diabetes, kidney problems, and malnutrition can cause nerve damage too. In some people, the cancer itself may be the cause of neuropathy.

Doctors can't do much to prevent neuropathy from developing, but one medication, amifostine (Ethyol), has been shown to protect nerves and tissues from damage when given to patients before chemotherapy begins. If possible, before your parent begins chemotherapy, talk to his doctor about which chemotherapy agent she plans to use and, if it's one that's likely to cause neuropathy, request amifostine as well.

A few small recent studies have shown that the minerals calcium and magnesium, given intravenously as part of hydration during chemotherapy, can help prevent neuropathy. This is also worth discussing with your parent's doctor ahead of time.

If your parent complains of numbness or tingling, tell his doctor, who will administer tests to evaluate the strength of sensation in your parent's hands, feet, arms, and legs. The doctor may also test your parent's reflexes to see whether muscles are affected.

As your parent's caregiver, it's important to recognize neuropathy as soon as possible because the loss of feeling can prevent your parent from being able to do certain tasks, such as buttoning clothes, holding onto pots and pans, and driving. It can be frightening and dangerous for your parent to spill a pot of hot water or to stumble and fall.

If your parent begins losing feeling in his hands and feet as a result of nerve damage, he's going to be prone to small injuries and infections that could go unnoticed. Your parent should avoid using knives, scissors, and other sharp objects as much as possible. Make sure, too, that your parent's fingernails and toenails are trimmed regularly, because with the loss of sensation, it's easy for him to scratch or hurt himself.

If it's your father who has neuropathy, suggest that he switch from a razor blade to an electric shaver. If it's your mother, take her for a manicure and pedicure, but tell the manicurist not to cut her cuticles to avoid infection.

At home, keep an eye on the thermostat, as extremes of hot and cold can cause increased pain for some people with neuropathy.

Neuropathy is usually treated with a combination of medications and nutrients. The doctor may start by prescribing a tricyclic antidepressant or anticonvulsant, depending on your parent's symptoms. Tingling and numbness usually respond well to antidepressants, while sharp stabbing pains respond best to anticonvulsants.

When talking to the doctor, describe your parent's symptoms of nerve damage as accurately as possible. Fortunately, the doctor has a long list of medicines she can try, so if one doesn't work, don't hesitate to ask for another.

In addition, a topical cream made from chili pepper extract (capsaicin) works well to relieve pain in the hands and feet. Some patients don't like it because it causes a burning sensation on the skin, but this feeling will go away if it's used regularly.

Chemotherapy can deplete your body of B vitamins and magnesium, and these deficiencies can cause neuropathy. You might want to have your parent take a combination B vitamin with plenty of folic acid and a magnesium supplement. Some cancer patients find that high doses of powdered glutamine also help.

Although neuropathy causes many cancer patients to feel less mobile, exercise is one of the best ways to prevent and treat neuropathy because it gets the blood flowing to the extremities. The most effective exercises for people with nerve damage are walking and swimming. If your parent has any interest in either of these, try taking him for a gentle swim or stroll. Before you go for a walk, make sure your parent has comfortable, sturdy walking shoes that fit well.

Neuropathy can cause a great deal of pain. If your parent is suffering, ask his doctor about prescription opioid pain medications, which can make day-to-day activities much easier to bear. Opioids can be given in combination with tricyclic antidepressants or anticonvulsants. Numbing lidocaine patches reduce pain in specific areas.

Many cancer patients have found acupuncture to be an effective means of controlling the pain of neuropathy. Doctors vary in their attitudes toward such alternative therapies, but there's growing acceptance of acupuncture for pain relief at many major cancer centers. As long as your parent's doctor doesn't actively oppose the use of acupuncture, it's worth a try. Your parent can let you know whether he feels better afterward or not.

In most cases, neuropathy triggered by chemotherapy goes away over time. However, long-term nerve damage sometimes results. If your parent is having trouble with mobility, ask his doctor what services are available. Physical therapy can help your parent regain strength and flexibility, while occupational therapy can help your parent learn strategies for daily tasks such as getting dressed and preparing meals.