In the Clinic

On Cancer: Managing Chemotherapy-Induced Peripheral Neuropathy after Cancer Treatment

Pictured: Gabrielle Miskovitz
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Memorial Sloan Kettering experts describe peripheral neuropathy caused by chemotherapy and offer tips for managing symptoms.

(45:00)

Though doctors and researchers are continually working to refine cancer treatments, therapies to treat the disease can still have side effects. Chemotherapy is often used as a strategy to kill cancer cells, but it can also affect the nerves that connect the spinal cord to muscles, skin, and internal organs. This condition is known as peripheral neuropathy.

“The likelihood that a person will develop neuropathy after cancer treatment varies widely, and is largely dependent on what kinds of chemotherapy drugs were given and the dosage that was used,” says Memorial Sloan Kettering physical therapist Laryssa Buoneto.

Symptoms of Neuropathy

A person’s particular symptoms related to neuropathy also may vary based on the type and dosage of drugs received. Certain types of chemotherapy affect the small sensory nerves in the feet and hands, causing symptoms such as numbness, tingling, and pain in fingers and toes. Treatment with chemotherapy can also result in weakness, muscle cramps, and muscle fatigue.

Less commonly, chemotherapy can have an impact on the nerves that control movement and autonomic (internal) functions. People with autonomic nerve damage may become dizzy when sitting or standing up, or may experience urinary or bowel symptoms, blood pressure changes, or irregular heartbeat.

“People who experience any of these symptoms during or after being treated for cancer should discuss them with their doctor,” says Ms. Buoneto. “These symptoms are common after cancer treatment, but they may also have other underlying causes.”

Diagnosing Peripheral Neuropathy

The first step in diagnosing neuropathy is to meet with your oncologist to discuss your chemotherapy regimen, symptoms, and any preexisting medical condition that could cause similar symptoms. Your oncologist may refer you to a physiatrist (a doctor who specializes in rehabilitation), a physical therapist, or an occupational therapist for evaluation and treatment.

In a typical exam, you would be examined for cuts and injuries, which can occur due to decreased sensitivity of the skin, and evaluated for your reaction to light touch, sensitivity to sharp and dull stimulation, finger muscle strength, reflexes, balance, and autonomic symptoms.

You may also undergo neurophysiologic tests such as:

  • electromyography, nerve conduction studies, and quantitative sensory tests to further examine peripheral nerve function
  • laboratory tests to look for metabolic disturbances and nutritional deficiencies
  • imaging tests to look for other possible causes of nerve damage

“These tests also can help your doctor or therapist to tailor a treatment plan to your needs and to measure progress to see if treatments are working,” says Memorial Sloan Kettering occupational therapist Gabrielle Miskovitz. “During your evaluation, your physical or occupational therapist will ask you to think about your goals. The therapist is there to help you maximize your safety, reduce your risk of injury, and improve your quality of life.”

Treating the Effects of Neuropathy

Medications are available to reduce the pain and sensory symptoms related to chemotherapy-induced peripheral neuropathy. Memorial Sloan Kettering’s Integrative Medicine Service also offers a variety of complementary therapies — such as acupuncture, manual lymph drainage, and other therapies — to relieve your symptoms.

In addition, physical and occupational therapy can help those with neuropathy to improve balance and gait, fine motor skills, dexterity, and coordination. Many of the treatments are focused on decreasing the risk of falls, and injuries that can result from neuropathy.

To learn more about the diagnosis and treatment of chemotherapy-induced peripheral neuropathy, watch a video featuring Mrs. Buoneto and Mrs. Miskovitz.

Comments

My daughter has all of the above symptoms and has been diagnosed with arachnoiditis. She received radiation treatments at MSKCC in 1998 at age 13 because of a brain tumor. Have any studies been done on the after radiation effects on the spine ? She suffers daily with leg and thigh pain, is unable to work or go about a normal life of a normal 27 year old young woman.
Thank you for any information you can provide.
Susan Bologna

Hi, Susan. We are unable to answer specific medical questions on our blog. If your daughter would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225.

You can also find information about our program in pain management here: http://www.mskcc.org/cancer-care/palliative-care/pain-management

Thanks for your comment!

What are your thoughts on the "ReBuilder" (electronic relief) for treating neuropathy tingling and pain?

I have had neuropathy since breast cancer treatment 5 years ago. I've broken my left foot twice, once by simply standing up on it while it was numb. When I ask for help from my physicians at Northwestern Hospital they act as if it had no relationship with the cancer treatment. I am finally off of aromasin and it's generic version exemastine. How likely is it that the nerves could get better?

Tammy, unfortunately we are not able to answer personal medical questions on our blog. We recommend that you watch our video on neuropathy to give you some talking points to discuss with your doctors at your next visit. You can find the video here: http://www.mskcc.org/videos/playlist/neuropathy-care-survivors. Thank you for your comment.

I've a five year breast cancer survivor and I've had neuropathy
in my feet. My toes move continuously, but my main is that
my toenails come off once a year. Is this normal with neuropathy?

Bettye, we are unable to answer personal medical questions on our blog. If you would like to speak with a Memorial Sloan-Kettering doctor, please call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

my son suffers from neuropathy in his feet and two of his fingers. he is in pain constantly and can not sleep at night. he has been told by his doctor that there is nothing that can be done to relieve the pain. he had chemo treatment 5 years ago, is this true

Rosemary, unfortunately we are not able to answer personal medical questions on our blog. If you would like to speak with a doctor at Memorial Sloan-Kettering, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

I have neuropathy in hands and feet from chemo 2 years ago. I have
promblems with most medications and have had severe side effects from simple everyday drugs. I can not take Lyrica or Cymbalta and
have finally decided to try and talk myself out of all the pain and
discomfort.My suggestion to the medical profession is that
they question patients in depth before starting chemo. My problems
resulted from a triple dose due to timing ....time the rest of my life will pay for the rush to finish the treatments.

My daughter had Vincristine 7 years ago for cancer treatment. She now complains of tingling in her hands and feet. Is this from the chemo and what can be done to help?

Sue, we are not able to answer personal medical questions on our blog. If your daughter would like to make an appointment to speak with someone at Memorial Sloan-Kettering, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

My husband is suffering from peripheral neuropathy in the hands and feet. He was recently taken off Oxalliplatin as part of his chemo regimen. The doctor said it might take up to 6 months for this to correct. He has been undergoing acupuncture at Soan with no relief. What else is available to him?

I still have some neuropathy and chemo brain even two and a half years out from breast cancer treatment with the red devil, taxol and radiation. What has helped the most is acupuncture, reflexology, massage, yoga, swimming and walking (even though painful). Don't give up and don't give in even if some doctors pretend these conditions don't exist and insurance won't cover alternative treatments. Hang in there and keep moving! Try everything you can and see what works for you because most treatments are one size fits nobody.

Are there any significant studies concerning acupuncture as a treatment for CIPN in a post-chemo environment?

Hi Gary, we asked our Integrative Medicine Service about this. They said there are some preliminary studies that suggest acupuncture may be helpful in the management of CIPN. Authors of a systematic review on published literature about acupuncture as a methodology to treat CIPN found there is published research is available to support indications acupuncture may be effective in controlling symptoms and neural damage associated with CIPN (Franconi G, Manni L, Schröder S, Marchetti P, Robinson N A systematic review of experimental and clinical acupuncture in chemotherapy-induced peripheral neuropathy. Evid Based Complement Alternat Med. 2013;2013:516916. http://www.ncbi.nlm.nih.gov/pubmed/23983788). However the amount is limited and more research is needed. If you or someone you know who is a cancer survivor wants to pursue acupuncture, please remember that it's important to see a licensed practitioner who is trained to work with cancer patients. Thank you for your comment.

After completing chemo for colon cancer, my husband developed a severe form of neuropathy that has left him crippled since November of 2012. He is unable to walk or stand erect. He has been diagnosed but no treatments were offered...only lots of narcotics for the pain. We are both desperate to find some sort of therapy that could bring any relief. It seems there is no way out of this situation and I fear the toll it has taken on us both. Please help.

Faye, we're sorry your husband is going through this. If you would like to make an appointment with a Memorial Sloan-Kettering doctor, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment for more information. Thank you for your comment.

I was diagnosed with peripheral neuropathy with no known cause. Is this possible without a underline problem?

Charlotte, unfortunately, we are unable to answer specific medical questions on our blog. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

Hi, I contracted breast cancer May of 1999 they did a mastectomy with reconstruction surgery using the latissimus dorsi muscle. I have nerve damage and I have tried everything, and I'm only getting worse. I am currently disabled. Basically my life is over unless I can find a cure. I am so tired all the time, and so tired of living in so much pain. Makes you wonder why you survive breast cancer just to suffer. Is their anything that can help me? Please, I'm desperate

Lisa, we are sorry to hear about your condition. If you'd like to learn more about coming to Memorial Sloan-Kettering, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment for more information. Thank you for your comment.

My uncle has an appointment with a doctor from MSKCC Integrative Medicine Services in February for his neuropathy. In the meantime, are there any supplements that have shown improvement (no matter how slight) for neuropathy? Someone suggested glutamine.

Alison, we are not able to provide individual medical advice on our blog. We recommend that your uncle wait until he is able to meet with our doctor in February. If you are interested in learning more about herbs and other supplements, you can visit our About Herbs database at www.mskcc.org/aboutherbs. We also have a mobile app that's available from the iTunes store. Thank you for your comment.

Is MSKCC currently participating in any CIPN studies where they are looking for volunteers for new treatments? I am currently on 1,200mg of Neurontin daily and I believe I am at the end of what this medication can do for me. Gabapentin does not work and Lyrica resulted in too many side effects including drastic changes in my eyesight. I would be happy to step forward if there is a study and I would qualify. My CIPN was a result of Oxaliplatin Chemtherapy.

James we suggest you contact our Integrative Medicine Service 646-888-0800 or contact the National Cancer Institute at 1-800-4CANCER to learn about any possible studies on CIPN.

To learn more about the diagnosis and treatment of chemotherapy-induced peripheral neuropathy, watch a video featuring Mrs. Buoneto and Mrs. Miskovitz.

What happened to the video? I'm getting a message back that it is no longer available. ?..

Cheryl, we're very sorry you were having problems with our website last night. The video seems to be working this morning. You can find it here: http://www.mskcc.org/videos/playlist/neuropathy-care-survivors

Thanks for your comment!

after 500-700 milligrams of hydroxyurea daily for about a year,
the underpart of my toes was itching and painful particularly in
summer, when feet sweat. I experienced an immediate reduction
in the pain and soon discontinuation of pain after taking daily packet
of EMERGEN - C multivitamin drink including other vitamins and minerals, particularly B12. I take it daily and there has been no recurrence in 3 years.

Hey there,
1 year ago my mother was diagnosted with a hormone sensitive breasttumor. The treatment concisted of 8chemo and 17 herceptin treatments.
My mom has finished her chemotherapie with docetaxel on 20-12-2013 and is experiencing heavy neuropathic soreness as a result of it.
She tried too inform her oncologist after the 2nd treatment about the complications and all he suggested was a pill too drain some fluid from her legs.
Now after the chemo she is still required too take 12 herceptin doses even though the feeling in her legs in unbareable for her, the neurologist examinend her and told her it is a very uncommon side affect and could not treat her in any way... She has too sit it out and hope for the best....
Now I see alot of ppl talking about neurotin and other reliefers of pain or soreness.
Is this a proper 'treatment' too hope for the best...
Can anyone plz inform me of the possible steps too take or some words of comfort.
Love her too death and cant bare too see her in the pain and life condition she is in right now
Sincerely Peter - Holland

Peter, we're sorry to hear about your mother's side effects. We're not able to answer individual medical questions on our blog, so we recommend your mother speak with her medical team about options for pain relief. If she'd like to speak with a doctor at MSKCC, you can call 800-525-2225 to make an appointment. Thanks for your comment.

dead link

Curtis, we're sorry you were having trouble with the links earlier. The video is working now. Thank you for your comment.

The video link is saying the video is not currently available.

Dear Anne, we are sorry you are having trouble with the video. It currently seems to be working. Here's a direct link to the video - hopefully this will work for you: http://www.mskcc.org/videos/playlist/neuropathy-care-survivors
Thanks for your comment.

I work at a small Breast Cancer Center in Brisbane Australia .
I will be visiting New York in the first week of May and was hoping to meet with your Occupational Therapist treating the physical impairments secondary to cancer treatments. Do you have visiting OT opportunities?

Denise, please contact Memorial Sloan Kettering's Bobst International Program at intnlprg@mskcc.org. They may be able to assist you. For more information about occupational therapy at Memorial Sloan-Kettering, go to http://www.mskcc.org/cancer-care/rehabilitation-services/rehabilitation-medicine-occupational-physical-therapy. Thank you for your interest.

I was operated on in 2010 for cooon cancer. After seven months of intensive cheomatheray, with platinum, I was pronounced clean, Since then I haqve gone in for the normal check up and things are noemal. The problem is that my toes, fingers, and now my fet and lower legs, the upper outside ov both hands suddenly become numb and my fingers lock up until II force them open. have fallen many times and br0ken an arm, rib and toe. I have gad in-grown nails problem.My doctors say there s nothibg to do, Any suyggestions?

Jerry,

Thank you for your comment. Unfortunately, we cannot answer personal medical questions on this blog. We suggest you speak with your physician about the conditions you are experiencing. There may be physical therapy exercises that could alleviate these problems. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225.

Why have a site where people are tempted to comment, and then you carefully take time to tell each and every person that you cannot answer their individual comments. How SAD for those people. (I am not one of them, but feel sorry for them.) There must be a better way.

Evans, when people ask general questions about cancer or cancer research, we always try our best to answer those questions, often going back to the clinicians or researchers featured in the blog post for more information. However, when people ask questions like "should I undergo x procedure?" or "what can be done for my individual condition?" we are not able to provide medical advice and answer those kinds of personal medical questions. When those situations arise, we always try our best to refer people to the proper resources for getting the answers they need. Thanks for understanding our comment policy.

My mother is 83 and was an active, independent woman until undergoing 4 rounds of RChop. I am so ANGRY and FRUSTRATED with the general attitude of Oncology. I've been researching for over a month and have found nothing but suffering. 9 times out of 10 these poor people have no hope and it appears the general attitude in the oncology community appears to be indifference. We told the oncologist immediately of any symptoms, as we were told to do in the information we received prior to starting chemo, but they DID NOTHING!!! When we complained to my mother's oncologist that my mother had tingling in her fingers which progressed to the complete loss of the use of her hands the response was just a shrug of the shoulders. When we continued to tell the oncologist that my mother had grown continually weaker and was unable to stand up or walk, the oncologist answered, "I don't understand it - I just don't know what's going on." At the time I didn't blame her - I know doctors are not all knowing - they are human but after researching the internet (the least SHE could've done!) I found out that CIPN is a well-known and documented occurrence for people on certain chemo drugs. My mother has started intense physical therapy as prescribed by a neurologist - there are no guarantees but I am hoping and praying she will get back on her feet. I just can't believe the medical profession appears to be ignoring these pleas for help and leaving all these people with no hope. It's despicable.
Oncologist, pay attention to your patients - don't forget to treat the whole person and not just the cancer.
For all those out there, searching for answers, I promise, if therapy helps my mother, I will post again. I know how it feels to be lost and hopeless and God knows, so does my mother.

We have come a long way with medicine and technology but is always a work in progress. Very happy to see some of you have experienced and benefited from Reflexology and Massage therapy. Please look into it if you haven't. As a therapist for 20yrs, now in Northeast Tn, I can attest to the joy of some pain relief as far as greater benefits I have had the pleasure of providing.

My friend received treatment for breast cancer almost 20 years ago and now has peripheral neuropathy in one arm and hand to the extent that she can no longer use that arm or hand. Are there any clinical trials available that could help her?

Jo Ellen, thank you for your comment. We do not currently have any clinical trials for neuropathy at MSK, but there appear to be such trials listed at the US government's clinical trials website at this link:

https://clinicaltrials.gov/ct2/results?term=neuropathy+AND+chemotherapy&Search=Search

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