What Is Neuropathy

Neuropathy and Chemotherapy: What You Can Do
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Neuropathy Symptoms

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.

Neuropathy Causes

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.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio

almost 4 years, said...

So, can I assume that I have neuopathy since my legs ache all the time now? This started 2 months after I finished Paclitaxel for breast cancer. It's constant and stopping me from sleeping without a sleeping pill. My oncologist says this has nothing to do with the chemo but I am hearing the same complaint from others. I will try the Gabapentin...any other advice on the "tens"?

about 5 years, said...

I have had unbearable face pain from trigeminal neuralgia for a few years now. I become nonfunctional. Been through my primary Dr. To a neurologist , who gave me medications that had side effects or did nothing for this pain. Finally I tried acupuncture. It has worked for me & left me pain free. Why will Medicare not pay for this treatment.

over 5 years, said...

Back in 2004 I was diag. with tonsillar cancer. Treatment was radiationchemo. which brought on a lot of sideeffects. One being nerve damage in the neck which I exper. 5-6 times a day like charlie horses in the neck. The doctor says that the radiationcheom damaged the nerve and when the nerve tries to come back alive it contracts the muscle and thats why i exper the charlie horses in my neck. He also stated this will get worse not better. What is your opioion?

almost 6 years, said...

My wife never received any pre-chemotherapy drugs. Following chemo course she contacted shingles. The doctors say, that shingles is the cause of her leg pain. thigh beeing the site of shingles. your article will provide a new approach to discuss matters with her doctors

about 6 years, said...

I needed to better understand the after effects of chemo drugs, and understand options for increasing my quality of life.

about 6 years, said...

after finishing my treatment for lung cancer in 09 i am now beginning to feel tingling toes feet hands sometimes fingers with frozen aems and legs ,i am now prescribe by my doctor gabapentin tablet . they do help but if there is another solution please share it

about 6 years, said...

I have neuropathy but have never been a cancer patient. Why do I have neropathy? This article didn't tell me.

over 6 years, said...

this web-site is a wonderful help !

over 6 years, said...

It just helped me understand my chemo related neuropathy a little more!

over 6 years, said...

I am the caregiver for my wife. She suffers from radiation necrosis which I have seen very little information on but her symptoms are similar to early stages of dementia or alzheimers. She had so much damage to her brain from chemo and radiation for her small cell lung cancer (matasticized to brain) she is now incontenent, has to have help to be mobile, and is extremely forgetful especially with short term memory. Her doctors (neurologist and oncologist) say there is nothing that can be done for her brain damage. Any information you may have on caring for her lack of mobility and incontenence is greatly appreciated.

over 6 years, said...

Nerve damage is caused by diabetes n can cause bladder problems with constipation!

over 6 years, said...

can Ethyol be used before every round of Chemo. involving those drugs,or just the first one? My husband just finished 6 rounds of carboplatinol and Taxol-he has received 4 roundsevery year for the past 4 years,this time increased to 6.But never has this drug option been mentioned.

over 6 years, said...

My husband has stage 4 Penile squamous cell cancer with metastases to both lungs. He also has had an ileostomy for Crohns disease. Because of the Crohns disease,he can not take NSAIDs,aspirin,or other pain killers such as Vicodin.the only drugs he was able to take were Darvocet or Percodan and they have been discontinued - no one is making them..Does anyone have any suggestions as to what we can do make him comfortable? The Dr. says they will control the pain as needed,but last time he ended up with a bowel obstruction.

over 6 years, said...

Yes it was very informative and gave me a better understanding in order to have discussions with my doctor.

almost 7 years, said...

My husband has Neuropathy and takes Chemo, he too has problems walking and standing. We searched and asked the doctor, Pharmacies and anyone we could find for anything to help him. The doctor ordered a Power Wheel Chair for him, which he used almost all time when at home and used the clinic wheel chair, with my help, when he took Treatment. or made a doctor visit. Each time when he had a treatment ,his Neuropathy got worse. TGhe doctor did give him a prescription for Gabapentin, it helps with the pain. Finally I searched the internet and found a unit called THE REBUILDER, paid for by Medicare , we had to pay a small amount less than $300.00 because our secondary insurance would not pay for that amount, but some insurance companies will. He has been using this TENS unit since March 2011 and it is June, he has used the unit with precise instructions from the doctor who developed it and now he is using his cane and a walker, he is gradually getting his normal walking back but still uses the TENS unit because he still is taking Chemo. It will make a difference if you will only try it. The pain is very light at present. I wish I could offer more but this is the best thing I can at this time.

almost 7 years, said...

Staying current with neuropathy research--as I have it, too. Sometimes it is okay--other times very uncomfortable. Keeping busy helps.

about 7 years, said...

My son has severe headaches since a stroke last May(2010). He has pain meds but nothing that really helps the problem. I will continue with these articles.

about 7 years, said...

Hi mamag86, Thanks for your comment. I'm sorry to hear about your condition, that doesn't sound very comfortable at all! Certain vitamins and minerals will likely help with your anemia, but I'm not positive about your overall condition. The best advice I can give you is to consult your doctor about how vitamins will affect you. Thanks for your question, and I hope you feel better soon!! -- Emily

about 7 years, said...

very helpfyl, thanks

about 7 years, said...

I have been diagnosed with idiopathic peripheral neuropathy, which means they dont know what the heck caused it. I dont drink, I dont have diabetes, I have no cancer. It is c ausing all sorts of problems with my left foot, especially numb and cramping toes. They tell me I am mildly aenemic. Do you think doeses of vitamins and minerals might help. At present the only way I can walk without severe pain is to use an orthopedic boot.

about 7 years, said...

I am a transplant patient (I received a kidney which took care of my kidney failure and a pancreas which took care of my Diabetes) then up jumped the devil and I was diagnosed with stomach cancer 3/17/2010. I was given chemo before the tumor was removed. The treatment seems to have been successful but the chemo added to the neuropathy left by years of diabetes and now when I stand up my BP drops significantly - to the point that I would faint. My Dr. has me on Midodrine. Any information or suggestions welcome.