People with nerve problems caused by cancer treatment need to take care to prevent falls. Sometimes integrative medicine practices, advised by your doctor, can also help you to feel better.
Some cancer treatments cause peripheral neuropathy, a result of damage to the peripheral nerves. These nerves carry information from the brain to other parts of the body. Side effects depend on which peripheral nerves (sensory, motor, or autonomic) are affected.
Damage to sensory nerves (nerves that help you feel pain, heat, cold, and pressure) can cause:
- tingling, numbness, or a pins-and-needles feeling in your feet and hands that may spread to your legs and arms
- inability to feel a hot or cold sensation, such as a hot stove
- inability to feel pain, such as from a cut or sore on your foot
Damage to motor nerves (nerves that help your muscles to move) can cause:
- weak or achy muscles that may cause you to lose your balance, trip easily, or have difficulty buttoning shirts or opening jars
- muscles that twitch and cramp or muscle wasting (if you don’t use your muscles regularly)
- swallowing or breathing difficulties (if your chest or throat muscles are affected)
Damage to autonomic nerves (nerves that control functions such as blood pressure, digestion, heart rate, temperature, and urination) can cause:
- digestive changes such as constipation or diarrhea
- dizzy or faint feeling, due to low blood pressure
- sexual problems; men may be unable to get an erection and women may not reach orgasm
- sweating problems (either too much or too little sweating)
- urination problems, such as leaking urine or difficulty emptying your bladder
If you start to notice any of the problems listed above, talk with your doctor or nurse. Getting these problems diagnosed and treated early is the best way to control them, prevent further damage, and to reduce pain and other complications.
Ways to prevent or manage problems related to nerve changes
You may be advised to take these steps:
- Prevent falls. Have someone help you prevent falls around the house. Move rugs out of your path so you will not trip on them. Put rails on the walls and in the bathroom, so you can hold on to them and balance yourself. Put bathmats in the shower or tub. Wear sturdy shoes with soft soles. Get up slowly after sitting or lying down, especially if you feel dizzy.
- Take extra care in the kitchen and shower. Use potholders in the kitchen to protect your hands from burns. Be careful when handling knives or sharp objects. Ask someone to check the water temperature, to make sure it’s not too hot.
- Protect your hands and feet. Wear shoes, both inside and outside. Check your arms, legs, and feet for cuts or scratches every day. When it’s cold, wear warm clothes to protect your hands and feet.
- Ask for help and slow down. Let people help you with difficult tasks. Slow down and give yourself more time to do things.
- Ask about pain medicine and integrative medicine practices. You may be prescribed pain medicine. Sometimes practices such as acupuncture, massage, physical therapy, yoga, and others may also be advised to lower pain. Talk with your health care team to learn what is advised for you.
Talking with your health care team
Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:
- What symptoms or problems might I have? Which ones should I call you about?
- When will these problems start? How long might they last?
- What medicine, treatments, and integrative medicine practices could help me to feel better?
- What steps can I take to feel better? What precautions should I take to stay safe?
- Could you refer me to a specialist who could give me additional advice?
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Neuropathy is nerve damage that can cause tingling, numbness, and other sensations, often in the feet and hands. Neuropathy is a common side effect of chemotherapy. Doctors believe it happens because chemotherapy damages healthy cells, including nerves.
Chemotherapy can damage nerves that affect feeling and movement in the hands and feet. Doctors call this condition chemotherapy-induced peripheral neuropathy (CIPN). Symptoms can be severe and may affect a person’s quality of life.
A 2014 study of 90 people receiving chemotherapy found that about half had neuropathy, and 6.7 percent said it was a major symptom that doctors overlooked.
Doctors are unsure why some people have neuropathy, and others do not. The risk depends on the chemotherapy drug a person takes, which could be causing damage to the nerves.
In this article, we look at ways to prevent and treat CIPN, including natural and alternative remedies. We also list some of the chemotherapy drugs that cause CIPN and discuss symptoms and diagnosis.
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The best option for preventing neuropathy is by using a chemotherapy drug that is not likely to cause CIPN.
However, this is not always possible as cancer treatment is diagnosis-specific, which means the most effective drug may also be one that causes unpleasant side effects.
People should discuss their outlook and the risks and benefits of each treatment option with their doctor.
Some research suggests the following treatments might help prevent neuropathy:
Always talk to a doctor before trying any remedy to prevent CIPN.
Although there is no sure method for preventing CIPN, natural remedies may relieve symptoms.
It is essential to talk to a doctor before trying any natural remedy, even over-the-counter supplements that claim to be safe and natural, to make sure they do not interfere with treatment.
Lotions
Some lotions may ease symptoms. People can try experimenting with mild creams that are unlikely to irritate the skin. Massaging painful areas with lotion may also help.
Some lotions to try include those that contain cocoa butter and menthol.
Exercise
Exercise can increase blood flow to the hands and feet and may offer temporary relief from pain. One study showed that exercise improved symptoms, such as tingling and numbness in the hands and feet, in some people with breast cancer.
People should discuss the exercises that are best for them with their doctor. Low-impact activities, such as swimming, low-impact aerobics, or yoga, are the safest options.
Vitamins
Some research suggests that vitamin deficiencies may make CIPN worse.
Researchers are studying the possibility that certain vitamins or combinations of vitamins might help. However, a 2013 study in the journal Clinical Nutrition concludes that more research is necessary before doctors can recommend specific supplements.
A doctor can test a person’s vitamin levels and make sure they are not deficient. Anyone who is lacking vitamins in their diet can take supplements following a recommendation from their doctor.
Dietary changes
A healthful diet can help the body fight cancer more effectively and may also ease some side effects of treatment.
Research does not support a specific diet, but a healthful diet should focus on fruits and vegetables, lean proteins, and whole grains, as well as plenty of water.
If nausea caused by the chemotherapy makes it difficult to eat, people can talk to a doctor about nausea treatment options.
Massage
Massage improves blood flow and may offer temporary relief from symptoms.
Some people may tense their muscles in response to neuropathic pain and massage can help release this tension, which may prevent the pain from radiating.
A study outlined at the 2016 Palliative Care in Oncology Symposium and reported in Oncology Nursing News noted that people who had CIPN as a result of treatment for multiple myeloma saw an improvement in their symptoms after massage therapy sessions.
Other alternative remedies
Some people find relief from acupuncture, reflexology, chiropractic, and other forms of alternative medicine. However, many of these treatments need further research to confirm their effectiveness.
These remedies may also help some people cope with the stress of facing a cancer diagnosis and dealing with chemotherapy.
Research has not conclusively proven that these remedies work, but many people who have cancer are willing to try non-traditional strategies for comfort and psychological well-being.
People should talk to their doctor before trying alternative remedies.
No single medical treatment for neuropathy works for all or most people undergoing chemotherapy. Many treatments are still in the experimental stage.
The most effective treatment largely depends on the chemotherapy drug a person is taking. This is because different drugs damage different nerves.
Medication
Researchers are testing drugs to counteract the nerve damage that causes CIPN. Early research suggests some medications may help, depending on the chemotherapy drug a person uses.
However, a 2014 review from the journal Cancer Management and Research says current information on the effectiveness of these drugs is controversial and requires more study.
Neuromodulation
Neuromodulation works by training the brain to process nerve sensations differently. Though still experimental, the following treatments may help:
- neurofeedback, which conditions the brain to change the way it responds to pain
- scrambler therapy, which prevents injured nerves from sending signals to the brain
- repetitive transcranial magnetic stimulation, which uses magnetic pulses to encourage changes in the electrical activity in the brain
Adjusting chemotherapy dose
Medical treatments may not be effective for neuropathy, so the standard treatment of choice is to reduce the dose of chemotherapy.
A doctor may recommend more weekly treatments at half the dose or, in some cases, stopping chemotherapy.
The drugs most likely to cause CIPN include:
- paclitaxel
- cisplatin
- oxaliplatin
- epothilones
- thalidomide
- docetaxel
- bortezomib
- lenalidomide
- pomalidomide
- suramin
- vincristine
Numbness and tingling in the hands and feet are the main symptoms of neuropathy.
Some people have weakness and find it difficult to hold small objects. Symptoms can be severe and significantly impact a person’s quality of life.
Common symptoms include:
- pain in the hands and feet
- tingling or burning in the hands and feet
- shooting or electrical sensations in the hands, feet, or legs
- ringing in the ears
- difficulty picking up objects
- difficulty with tasks that require close control, such as buttoning a shirt
- very cold or hot hands or feet
- loss of balance
- painful or difficult urination
- constipation
CIPN is particularly problematic to treat because it is not possible to predict when symptoms may occur — sometimes, they develop after treatment has ended — or how long they will last.
A doctor can usually diagnose neuropathy by looking at a person’s symptoms, especially when they are taking one of the chemotherapy drugs that are known to cause neuropathy.
However, nerve pain may be due to something other than chemotherapy.
Other medical conditions that can cause neuropathy include:
- kidney failure
- diabetes
- autoimmune diseases
- infections
- carpal tunnel disorder
- alcohol abuse
- nutritional deficiencies
A doctor may conduct testing to rule out these other causes.
Neuropathy can be extremely painful, but it is not usually permanent. For most people, symptoms go away after they stop chemotherapy.
Sometimes it takes a few months for symptoms to fade. A 2014 study found that 30 percent of people still had symptoms of CIPN 6 months or longer after stopping chemotherapy.
In rare instances, neuropathy can be permanent, but there is no way to predict whether this will be the case. Although CIPN can be debilitating, it is important to keep in mind that symptoms almost always improve.