Peripheral Neuropathy In Persons With Cancer

What causes peripheral neuropathy?
Many diseases and conditions can cause nerve damage. The common causes are diabetes, alcoholism, vitamin deficiencies, HIV infection, and cancer. In persons with cancer, radiation treatments, chemotherapy or the cancer can be the cause of the nerve damage. This article is written primarily for persons who have developed peripheral neuropathy in the setting of cancer.

How will I know if I have peripheral neuropathy?
Symptoms of peripheral neuropathy depend on the type of nerve(s) affected and where the nerve is located in the body. More than one type of nerve can be damaged.

If nerves to the skin are affected:

• Numbness and tingling (pins and needle feeling)
• A feeling you are wearing an invisible glove or sock
• Extreme sensitivity to touch
• Burning feeling in toes or fingers
• Freezing feeling in toes or fingers
• Can’t feel hot or cold, or the ability to feel hot/cold is lessened

If the nerves to the internal organs are affected:

• Constipation
• Bladder difficulties
• Sexual dysfunction

If nerves to the muscles are affected:

• Muscle weakness (turning a knob)
• Muscle cramping
• Muscle spasms
• Problems with balance

What should I know about peripheral neuropathy?
It may be impossible to prevent early nerve damage. But it is possible to prevent it from worsening. The most important thing that persons with neuropathy symptoms can do is to tell their doctor or nurse immediately. The doctor may discuss with you whether or not to stay on the chemo drug, if that is felt to be the cause of the neuropathy.

What can be done for peripheral neuropathy?
If the nerve damage is due to a drug, the drug will be stopped. If it is due to tumor, the tumor needs to be treated, if possible. If it is felt to be due to a vitamin deficiency, vitamins will be prescribed by the doctor.

There are various remedies to soothe symptoms of peripheral neuropathy. Many patients learn what helps by means of trial and error. Some people need just one try to find what works for them. Others may need to try numerous methods. Sometimes a combination of methods will take away the symptoms. Patients need to tell their doctor/nurse what methods work or don’t work so that a plan can be formed.

Pain Management

• Medicines— peripheral neuropathy can be a chronic problem, so medicines are Non-narcotic pain relievers (Tylenol, Motrin)
• Narcotics— strong pain relievers can almost always relieve the pain of neuropathy, but the side effects can be a problem.
• Topical anesthetics— proven in clinical trials to decrease painful sensations of neuropathy
• Capsaicin cream— has been shown to decrease neuropathic pain. It is primarily recommended for foot pain.
• Tricyclic antidepressants— decreases the chemicals in the brain that transmit pain signals
• Anti-convulsants— helps calm down the peripheral and central nervous systems. Neurontin (gabapentin) is a commonly prescribed drug for neuropathy.

Exercise— prescribed by a physician and supervised by a physical therapist, can increase strength, circulation, and coordination. It is important to maintain as much muscle strength and function as possible.

Massage can increase circulation and promote relaxation. It is sometimes useful in treating the symptoms of peripheral neuropathy. Massage, in some conditions, could be harmful. Check with your doctor before having massage therapy.

Alternative/Complimentary Treatments (CAM)— there is not a lot written to support the effects of complimentary and alternative treatment of peripheral neuropathy, though some persons report being helped by them. Extra B vitamins and glutamine are commonly used CAM drugs for peripheral neuropathy.

If you have heard of a CAM treatment you want to try, talk to your doctor. University of Iowa Health Care has a CAM clinic. The doctors in this clinic will discuss these methods with you.

Safety Concerns
Persons with peripheral neuropathy are more prone to accidents or injuries because of the lack of sensation, weakness, and clumsiness that may come with damage to the nerves of the skin and muscles. Some of the safety measures that should be considered:

• Make sure the lights are on when entering a room
• Use a lighted key ring to open locked doors.
• Remove throw rugs. Clear walkways of clutter, toys, footstools
• Wear sturdy shoes. Avoid slippers and running shoes with thick soles.
• Wipe spills immediately
• Use skid free shower and bathroom mats
• Use liquid soap instead of bar soap.
• Clear garages and work areas of oil spills. Store rakes, nails and garden tools out of the walkways.
• Wear warm socks and gloves during cold weather.
• Lower water temperature in the home water heater to avoid burns. Use bath thermometer to make sure the water temperature of a shower or tub is 120 degrees or below.
• Use protective gloves when washing dishes.
• Evaluate your ability to feel brake pedals and steering wheel. Be alert for changes in reaction time.
• Be sure you have sufficient strength and coordination when driving.
• Use a cane if you find yourself limping or having difficulty walking (or use a walker if arms are weak).

Adaptive devices— if weakness of hands or feet interfere with daily activities, adaptive devices may be needed. An occupational therapist may be consulted to fit devices that will compensate for the muscle weakness.

Foot and Hand Care
It is important to maintain healthy skin when sensory nerves are involved. You may have lessened sensation and not be able to feel the discomfort that would normally alert you that a problem is present.

• Inspect hands and/or feet for sores or blisters.
• Avoid ill-fitting shoes and socks
• Moisturize feet and hands daily. Dry in between toes after bathing to avoid fungal infections.
• Keep toenails carefully trimmed. If hand weakness makes this difficult, a health professional, such as a podiatrist, can do this routinely.