Chemotherapy drugs are toxic to healthy nerve cells as well as to cancer cells. Neuropathy is the medical term for nerve damage, usually to the peripheral nerves in the hands, feet, arms, and legs. When those nerves begin to stop working, the result is tingling, numbness, weakness, pain, and even an impaired sense of touch.
Loss of feeling in the hands and feet can make it hard to pick up small objects and can 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 cisplatin (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.
Preventing Nerve Damage and Injury From Neuropathy
Before beginning chemotherapy, talk to the doctor about which chemotherapy agent she plans to use and whether it's one that's likely to cause neuropathy, so you'll be prepared and on the lookout for symptoms.
Unfortunately, doctors can't do much to prevent neuropathy from developing. There is one protective medication sometimes prescribed to patients before beginning chemotherapy, amifostine (Ethyol), but recent research has not substantiated its benefit.
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 worth discussing with the doctor ahead of time.
Testing for Neuropathy
If the person you're caring for complains of numbness or tingling, tell his doctor, who will administer tests to evaluate the strength of sensation in his hands, feet, arms, and legs. The doctor may also test his reflexes to see whether muscles are affected.
As a caregiver, it's important to recognize neuropathy as soon as possible because the loss of feeling can prevent patients from being able to do certain tasks, such as buttoning clothes, holding onto pots and pans, and driving. It can be frightening and dangerous to spill a pot of hot water or to stumble and fall.
Neuropathy and Injuries
If your loved one 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. That makes it important that he avoid, as much as possible, using knives, scissors, and other sharp objects. Make sure, too, that his 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 a man who has neuropathy, suggest that he switch from a razor blade to an electric shaver. If it's a woman, take her for a manicure and pedicure, but tell the manicurist not to cut her cuticles; this will help 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.
Managing Pain From Neuropathy
Neuropathy can cause a great deal of pain. If you see signs of suffering, ask the doctor about pain medication, which can make day-to-day activities much easier to bear. According to the latest research, analgesics are the best bet for controlling pain associated with neuropathy. Ask your doctor about the risks and benefits of over-the-counter and prescription painkillers and about topical analgesics such as numbing lidocaine patches, which can reduce pain in specific areas.
When talking to the doctor, describe the symptoms of nerve damage as accurately as possible. Fortunately, doctors have a long list of medicines they can try, so if one doesn't work, don't hesitate to ask for another.
One specific chemotherapy agent, oxaliplatin, causes toxicity that can be helped by taking calcium and magnesium. Talk to your doctor about it, though, because there is some concern that taking these minerals may decrease the effectiveness of the chemotherapy. In the realm of more alternative treatments, some patients find that a topical cream made from chili pepper extract (capsaicin) works well to relieve pain in the hands and feet. Some people don't tolerate it well because it causes a burning sensation on the skin, but this feeling will go away if it's used regularly.
Chemotherapy can deplete the body of B vitamins and magnesium, and these deficiencies can exacerbate neuropathy. You might want to suggest that the person you're caring for take a combination B vitamin with plenty of folic acid and a magnesium supplement (except if the chemotherapy is oxaliplatin; see above.)
Some cancer patients find that high doses of powdered glutamine help with neuropathy, but don't start any nutritional supplement without talking to your doctor about your specific treatment.
Alternative Treatments for Neuropathy Pain
Neuropathy and Acupuncture
Many cancer patients have found acupuncture to be an effective means of controlling the pain of neuropathy. Doctors vary in their attitude toward such alternative therapies, but there's growing acceptance of acupuncture for pain relief at many major cancer centers. As long as the doctor doesn't actively oppose the use of acupuncture, it's worth a try.
Exercise for Neuropathy
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 blood flowing to the extremities. The most effective exercises for people with nerve damage are walking and swimming. If the person in your care has any interest in either of these, try taking him for a gentle swim or stroll. Before you go for a walk, make sure he has comfortable, sturdy walking shoes that fit well.
When to Ask for Extra Help
In most cases, neuropathy triggered by chemotherapy goes away over time. However, long-term nerve damage sometimes results. If the person you're caring for is having trouble with mobility, ask the doctor what services are available. Physical therapy can help many cancer patients regain strength and flexibility, while occupational therapy can help them learn strategies for daily tasks such as getting dressed and preparing meals.