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Take Control of Chemotherapy-Induced Peripheral Neuropathy

by Cindy Tofthagen, PhD, ARNP, AOCNP, FAANP, FAAN

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Peripheral neuropathy is a common, but often unanticipated, side effect of chemotherapy. Symptoms in­clude numbness and tingling that begin in the fingertips or toes and that may move upward into the hands and feet, and then the arms and legs as the neu­ropathy worsens. Peripheral neuropathy can also affect your balance and fine motor skills, making it difficult to carry out certain daily activities like buttoning a shirt, hitting the right keys on your computer or cellphone, or driving a car.

Talk to your doctor if you are experiencing symptoms of neuropathy. You’ll want to tell him or her how much of your hands or feet are affected, what specific symptoms you’re having, and how the symptoms are affecting your daily activities. If you are currently being treated with chemotherapy, your doctor may need to adjust the dose or try a different chemotherapy drug altogether. For most people who develop chemotherapy-induced neuropathy, symptoms will lessen or resolve over time.

Controlling neuropathy pain usually requires medications that are different from those used for other types of pain.

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Dr. Cindy Tofthagen

Your doctor may refer you to a neu­rologist (a doctor who specializes in the treatment of diseases affecting the nervous system) to rule out other dis­eases or conditions that may be causing your neuropathy. A neurologist can also help you manage your symptoms.

For some people, chemotherapy-induced peripheral neuropathy can cause a great deal of pain. Controlling neuropathy pain usually requires medications that are different from those used for other types of pain. Two main kinds of drugs are used to treat neuropathy pain: anti-seizure medications and antidepres­sants. These medicines must be taken on a regular basis, instead of as-needed like other pain relievers, and it may take some time before you notice results. Also, not every medicine works for everyone, and different people require different dosages to get pain relief. Your doctor can help determine what type of medicine and dosage you need to con­trol your neuropathic pain.

If neuropathy is affecting your abil­ity to perform normal activities, seek help as soon as possible so that you can get your symptoms under control and get back to living your life. Several different types of healthcare providers can help you manage your neuropathy:
A physiatrist (a physician who spe­cializes in cancer rehabilitation) can help get you functioning at your best.
A physical therapist can help you manage neuropathy by recommending specific exercises to improve your muscle strength and balance.
An occupational therapist can work with you to help you maintain your inde­pendence, adjust to physical limitations, and get back to doing your usual activi­ties as quickly as possible.
A podiatrist can help you take good care of your feet, recommend good foot­wear, and fit you for special inserts that will make walking more comfortable.
Case managers, registered nurses, and social workers can help you identify resources within your community to meet your specific needs and facili­tate communication among you, your healthcare team, and insurance company.
Mental health professionals and support groups can help you cope emotionally with neuropathy.

Always check with your doctor before taking any vitamins, nutritional supplements, or over-the-counter medicine for neuropathy because these may in­terfere with your cancer treatments or may have other potentially harmful effects. Be leery of anyone who tells you they have a “cure” for neuropathy. Numerous unproven treatments are claimed to cure or improve neuropathy; however, these may cost you a lot of money and not deliver the results they promise.

While there is no magic bullet for neu­ropathy, there is a lot you can do to control neuropathy symptoms. You can start with talking to your doc­tor about your chemotherapy-induced peripheral neuropathy symptoms and then being persistent until you get the help you need.

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Dr. Cindy Tofthagen is an associate professor, oncology nurse practitioner, and director of the oncology nurse practitioner concentration at the University of South Florida in Tampa, FL. She is the director of CARE Tampa Bay, a member of the medical advisory board for the Neuropathy Support Network, and con­tributor to the Oncology Nursing Society’s Putting Evidence into Practice guidelines for peripheral neuropathy.

The Neuropathy Support Network is a nonprofit organization that helps people with any form of neuropathy. Visit NeuropathySupportNetwork.org to learn more about neuropathy or to find a sup­port group in your area.

This article was published in Coping® with Cancer magazine, September/October 2016.