Peripheral Neuropathy

One common neurologic complication of cancer is peripheral neuropathy. This condition can cause numbness, pain and tingling in certain areas of the body, particularly in your extremities (e.g., hands and feet). The Neuropathy Association estimates that about 20 million Americans suffer from peripheral neuropathy.


What is Peripheral Neuropathy?

Peripheral neuropathy is a term used to describe damage to the peripheral nerves, or the nerves located outside of the brain and spinal cord (i.e., the central nervous system). The peripheral nerves transmit information back and forth between the central nervous system and the rest of the body. Damage to the peripheral nerves interferes with these vital connections. It disrupts the body’s ability to communicate with its muscles, skin, joints, or internal organs. This can lead to changes in sensation, muscle function and coordination.


How are Peripheral Neuropathies Classified?

According to the National Institute of Neurological Disorders and Stroke (NINDS), more than 100 types of peripheral neuropathy have been identified, each with its own set of symptoms, pattern of development and prognosis. Peripheral neuropathy can be broadly categorized by the type of nerve (e.g., motor, sensory, or autonomic) that has been damaged.          


Each nerve has a highly specialized function in a specific part of the body. Motor nerves are responsible for muscle tone and voluntary movement, such as walking, grasping things, or talking. Sensory nerves are responsible for sensing touch, pain, temperature, and position. Autonomic nerves are responsible for involuntary functions, such as breathing, blood pressure, digestion, and bowel and bladder functions.


Peripheral neuropathy may affect a single nerve or several. For example, in polyneuropathy, multiple nerves are affected in different areas of the body.


Symptoms of Peripheral Neuropathy

Symptoms of peripheral neuropathy vary from person to person, depending on the type and number of nerves that are damaged. Peripheral neuropathy symptoms usually start at the end of the extremity and gradually move upward. Thus, the areas of the body most commonly affected by peripheral neuropathy are the toes and fingers.


Peripheral neuropathy symptoms may be mild and come and go, or slowly progress over many years and become more severe. Depending on which nerves are affected, some potential symptoms of peripheral neuropathy may include the following:

  • Numbness, pain and/or tingling, especially in the feet or hands
  • Muscle weakness/atrophy
  • Burning, shooting or electric-like pain
  • Pinching, pricking, “pins and needles” sensation
  • Sensitivity to touch or temperature
  • Balance and coordination problems
  • Dizziness or lightheadedness, especially upon standing
  • Changes in the skin, hair and nails
  • Sexual dysfunction, organ or gland dysfunction
  • Gastrointestinal issues (e.g., diarrhea, constipation, digestion problems)
  • Difficulty breathing, paralysis or organ failure (in extreme cases)


Causes of Peripheral Neuropathy

There are many causes of neuropathy. The Neurological Association reports that diabetes is the most common cause of neuropathy, accounting for about 30 percent of cases in the United States. Some other causes that have been linked to peripheral neuropathy are as follows:

  • Cancer and cancer-related disorders (e.g., a tumor pressing on a nerve)
  • Physical injury/trauma
  • Some cancer treatments (e.g., chemotherapy, other drug therapies, radiation)
  • Autoimmune disorders (e.g., lupus, rheumatoid arthritis)
  • Malnutrition
  • Alcohol abuse
  • Infections (e.g., HIV/AIDS)
  • Exposure to toxic substances
  • Other diseases (e.g., forms of kidney disease)
  • Hormonal imbalances (e.g., hypothyroidism)
  • Heredity conditions (e.g., Charcot-Marie-Toothe disease)


Peripheral neuropathy can be difficult to diagnose. A diagnosis of peripheral neuropathy may involve a medical history, physical and neurological examination, supporting laboratory tests, and other tests of muscle strength, function, posture, and coordination.


Cancer-related Peripheral Neuropathy

Cancer-related peripheral neuropathy may develop during the course of cancer treatment, or shortly after. It may also progress slowly and develop months or even years after treatment is complete. Each individual’s experience of peripheral neuropathy is different. Some patients notice mild tingling. Others experience burning pain, numbness and weakness. These unpleasant sensations can occur in response to touch, temperature, or with no stimulus at all.


Moreover, peripheral neuropathy can be an upsetting complication of cancer. It can make daily activities, such as walking, standing, picking up objects, and buttoning clothing difficult. In addition, pain and weakness from neuropathy can affect your emotional well being and overall quality of life. Thus, it is important to find ways to manage peripheral neuropathy.


Managing Peripheral Neuropathy

One way to manage peripheral neuropathy is to treat the underlying cause. For chemotherapy-induced peripheral neuropathy, most interventions are supportive, designed to improve symptoms and function. To prevent the neuropathy from worsening, the patient’s doctor may reduce the chemotherapy dosage or switch to a different drug.


Another way to manage peripheral neuropathy is to control painful symptoms. Many types of medications may help to relieve neuropathic pain, including analgesics as well as some anti-seizure medications and antidepressants. A nerve block (e.g., an injection of an anesthetic agent directly near a nerve) may also be used to treat pain.


In addition, adopting a healthy lifestyle, including a well-balanced diet and rehabilitation exercises, may also help to reduce the symptoms of peripheral neuropathy.


Can Peripheral Neuropathy Improve?

Depending on the type of nerve damage involved, some peripheral neuropathies can improve and heal over time if the underlying cause is removed. As long as the nerve cell itself has not been destroyed, peripheral nerves usually have the ability to regenerate.


While recovery from peripheral neuropathy tends to be slow, steps can be taken to encourage regeneration of the damaged nerves. And, even if symptoms do not completely go away, a cancer patient may be able to find therapies to help manage peripheral neuropathy.


Note: This information is not intended nor implied to be a substitute for professional medical advice. Cancer patients should always report any symptoms of peripheral neuropathy to the physician immediately.


Tips for Managing Cancer-Related Peripheral Neuropathy

When ministering to a cancer patient with cancer-related peripheral neuropathy, here are some tips you can share:

  • Be your own advocate. It’s important to educate yourself and speak up about your symptoms, so you get the care you need. The more you understand about peripheral neuropathy, the better able you will be to accurately describe your symptoms to your doctor. A greater understanding can also help you make more informed decisions about your treatment and better explain what you need from your family members, friends and health care team.
  • Practice proper pain relief. It’s important to stay on top of pain. Your doctor may recommend over-the-counter pain medications for mild pain. For more severe neuropathic pain, your doctor may prescribe analgesics (i.e., painkillers), topical treatments (e.g., lidocaine patches), or antidepressants to help control pain. A pain specialist can work with you to try to find a balance between pain relief and quality of life.
  • Use safety precautions. Since peripheral neuropathy may cause a lack of pain sensation, you may receive a burn or wound and not feel it. Make sure you inspect the skin on your hands and feet daily for any signs of blisters, sores or cuts. Use a thermometer to check that your bathwater/dishwater temperature is below 110 degrees Fahrenheit. Use potholders while cooking, rubber gloves when washing dishes, and shield your fingers while cutting foods.
  • Be careful when driving. Neuropathy can slow your reaction time when driving. Make sure you can fully feel the gas and brake pedals and steering wheel. You should be able to quickly move your foot from the gas to the brake. If neuropathy affects your ability to drive, it can be upsetting. You may feel you are losing your independence. However, remember that your safety and others’ safety on the road is most important.
  • Establish a safe home environment. To prevent falls and other injuries, it is important to adapt your home environment. Keep all rooms, hallways and stairways well lit. Use a night light in your bedroom to light your path if you need to use the bathroom during the night. Install handrails on both sides of stairways and cover your stairs with a non-slip surface or safety treads. Remove small rugs and any other clutter that could cause you to fall. Also, install grab bars in the shower or handgrips in the bathtub, and lay down skid-free mats. Secure any extension cords along the edge of the floor with electrical tape. Use lightweight, non-breakable glasses, utensils, plates, and pans.
  • Use assistive devices. Assistive devices can help compensate for muscle weakness, reduce pain and improve function. Try using a cane or walker, orthopedic shoes, splints, or braces. If you have difficulty dressing, use button hooks, ring and zipper pulls, in-step supports for slippers and shoes, and cuff and collar extenders. A long-handled reacher can help you retrieve items on high shelves and pick up objects that fall to the floor. Large rubber non-slip handles can make it easier to open jars, cut food, and peel vegetables.
  • Maintain adequate nutrition. Since vitamin deficiencies can cause damage to nerve tissue, a healthy, well-balanced diet is especially important during this time. A registered dietitian can help develop an appropriate meal plan, which may include a diet rich in B-12 vitamins, protein, thiamine, and antioxidants. It is also very important to avoid alcohol and tobacco.
  • Visit a rehabilation therapist. If your hands and feet are numb, you may have difficulty walking, grasping things, or performing daily activities. A rehabilitation therapist can help you strengthen muscles that are weak, reduce cramps and pain, and improve coordination and balance. Rehabilitation therapists can also recommend assistive devices and special equipment to help make it easier for you to perform your usual daily activities.
  • Try complementary medicine therapies. Complementary medicine therapies, under the supervision of a clinician, may help to relieve symptoms of peripheral neuropathy. Acupuncture uses thin needles applied to specific areas of the body, or acupoints, to stimulate energy flow. This technique may help to restore balance and control pain and other symptoms. Massage may also help to improve circulation and decrease pain. In addition, relaxation techniques and other mind-body medicine therapies may help to reduce mental and emotional distress.
  • Share your feelings with others. Dealing with peripheral neuropathy can be a long and frustrating process. You may feel upset if recovery is slow or if symptoms don't improve. Be open with your family and friends about what you're experiencing. Support groups can also help you understand that you are not going through this alone.


Note: This information isn’t intended nor implied to be a substitute for professional medical advice. Always suggest that cancer patients seek the advice of their physician or other qualified healthcare providers regarding peripheral neuropathy.