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Peripheral Neuropathy

That tingling and numbness you feel in your hands and feet may be a common (and treatable) side effect of cancer therapy.

by Nessa Coyle, NP, PhD, and Julie K. Silver, MD

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Cancer survivors may experience nerve pain, often described as tingling, burning, or numbness. They may also have problems with balance and coordination if the symptoms are in the feet. If the hands are involved, survivors may complain of dropping items or having difficulty buttoning shirts or using a cell phone.

These symptoms often occur due to a common cancer-related problem called peripheral neuropathy. With this condition, nerves outside the brain and spinal cord have been injured, often by cancer treatments like chemotherapy. Sometimes, the symptoms are temporary and gradually decrease after cancer treatment is completed. Other times, the symptoms persist, requiring ongoing medical attention and care. Peripheral neuropathy may affect one nerve or several – what doctors often call a “stocking” or “glove” distribution, meaning that the problem involves the part of the foot or hand that would be covered by a stocking or a glove.

Chronic health problems, such as diabetes or excessive use of alcohol, can also cause or contribute to neuropathy.

Author of Article photo

Dr. Nessa Coyle

Although peripheral neuropathy may be a side effect of cancer treatment, it may also be caused by or exacerbated by other conditions not associated with cancer. This is why it is so important to get a proper diagnosis for this condition.

Causes of Peripheral Neuropathy
In cancer survivors, peripheral neuropathy is usually caused by damage to nerves from surgery, radiation treatment or chemotherapy. The latter is called chemotherapy-induced peripheral neuropathy, or CIPN. Nerves also may be injured by a tumor pressing on them. Chronic health problems, such as diabetes or excessive use of alcohol, can also cause or contribute to neuropathy. CIPN, the most common type of cancerrelated neuropathy, generally affects the hands and/or feet.

What to Do if You Think You Have Peripheral Neuropathy
If you suspect that you have peripheral neuropathy, you should

  • Report any new symptoms to your doctor – the right diagnosis is essential.
  • Avoid self-medicating, and talk to your doctor about appropriate treatment for peripheral neuropathy. If you are in active treatment, your doctor may want to change your regimen, such as adjusting your chemotherapy dosage.
  • Limit or avoid drinking alcohol; it is toxic to nerves.
  • Control your blood sugar if you have diabetes.

Treatment Options for Peripheral Neuropathy
Peripheral neuropathy can be treated with both prescribed medications and non-pharmacologic methods.

Author of Article photo

Dr. Julie Silver

♦ Medications Your doctor may prescribe different classes of drugs, such as antidepressants, antiseizure medications, topical local anesthetics, and opioids. Regardless of what your doctor prescribes for the discomfort, it’s best to keep ahead of the pain. Don’t wait until you are miserable to take the medication.

♦ Non-pharmacologic treatments There are many non-pharmacologic treatments for peripheral neuropathy, including relaxation therapy, meditation, acupuncture, and transcutaneous electrical nerve stimulation (TENS). Physical therapy and occupational therapy can also be extremely helpful in promoting strength, balance, and coordination.

Managing Peripheral Neuropathy
There are several things you can do at home to improve function and lessen neuropathic pain. Pay extra attention to your feet if that is the area of your neuropathy. At least once a week, use a handheld mirror to check your feet for sores or open wounds. Comfortable shoes are important. Look for extra-depth and extra-width shoes. Rocker bottom soles might also make walking more comfortable. A cobbler can put a rocker bottom sole on most shoes (except high heels).

You should also pay close attention to your hands if they are affected. If your hands feel clumsy or weak, consider buying household tools, such as kitchen knives and hammers, with a wide grip. Use electric appliances, like can openers, rather than manual ones.

Cancer treatments can wreak havoc on your body. However, you deserve to live with as little disability and pain as possible. If you have pain or problems with balance or coordination from neuropathy, ask your doctor for a referral to a specialist who treats these issues.

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Dr. Nessa Coyle is a nurse practitioner in the Supportive Care Program of the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center in New York, NY. Dr. Julie Silver is an assistant professor at Harvard Medical School. She is the author of What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope (American Cancer Society, 2009) and is the founder of Oncology Rehab Partners (www.OncRehab.com).

This article was published in Coping® with Cancer magazine, November/December 2009.

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