What is Chemotherapy Induced Peripheral Neuropathy (CIPN)?
Some forms of chemotherapy can affect or cause damage to your nerve endings, most commonly your sensory nerves. Your sensory nerves tell your brain to feel certain sensations such as touch, heat, cold and pain. When these nerves are damaged, you can have difficulty feeling these sensations correctly. It can lead to tingling, burning or numbness in your hands or feet, usually starting with your toes or fingers and gradually moving toward the centre of your body. It can cause debilitating pain, difficulty feeling hot or cold temperatures and can reduce your motor functioning.
While neuropathy cannot be cured, there are ways to manage your pain. For many with CIPN, your symptoms often dissipate 3-6 months after treatment ends. But for some, including people who have metastatic disease, your neuropathy may not go away at all. Here’s some tips for managing your pain.
If you’re experiencing neuropathy in your feet it’s important to find comfortable fitting shoes and socks. You’ll want to buy shoes with a wide edge, ample space around your toes and good arch support. Consider wearing diabetic socks which are specifically designed to help with neuropathy in your feet. They offer a proper fit, soft material and fewer seams that can reduce the pain and potential injury caused by ill-fitting, uncomfortable socks. Proper fitting shoes and socks can help to reduce the pain you’re feeling.
Be mindful when you come in contact with potentially extreme hot or cold temperatures. Because of the reduced sensation, you might not notice when water or kitchen items are too hot which could lead to unseen burns. The same is said for extreme cold temperatures. Be sure to keep your extremities covered and warm during the winter months to avoid frostbite.
As much as possible, try to avoid injury to your hands or feet. Ensure your house is well lit, and remove any potential tripping hazards. Be careful using sharp objects and try to wear gloves when gardening or washing dishes. Inspect your hands and feet regularly to ensure that you have not cut or burned your skin. Oftentimes, the numbness or tingling can cause injuries to go unnoticed.
There are several types of integrative approaches you can take to help alleviate pain from your neuropathy. Massage can potentially help to improve your circulation, decrease pain, lower anxiety or depression and increase flexibility. Evidence suggests that forms of relaxation therapies including meditation, yoga and Reiki can have a positive effect on reducing pain and also on reducing the anxiety caused by the pain of neuropathy.
Acupuncture, a key part of Traditional Chinese Medicine, has become more and more accepted in western medicine with many studies (see here and here) proving its positive affect on improving a wide range of symptoms and side effects, including chemo induced neuropathy. It has been shown to not only reduce neuropathic pain but improve functioning in the effected areas.
Transcutaneous electrical nerve stimulation (TENS) is a form of therapy that sends small currents of electricity to nerves in the affected area. Studies have shown that it can be used successfully to treat nerve pain and increase functioning.
Be sure to speak with your doctor first if you’re interested in trying these integrative approaches to your pain management.
Peripheral neuropathy can sometimes cause balance and mobility issues. Physical therapy can help to strengthen your weakened muscles and improve your motor functioning. Physical therapists can teach you balance training exercises that can help with your stability and safe stretches to help with your range of motion. Alternatively, an occupational therapist can help you learn self-care and safety techniques so that you can avoid trips or falls. They can also help to improve your sensory and motor skills and they can teach you techniques for everyday tasks that you may now struggle with. Talk with your doctor about finding a physical or occupational therapist that specializes in chemo induced peripheral neuropathy.
There are many supplements available that are known to help reduce the side effects of neuropathy, prevent further deterioration of your nerves and potentially help heal the damage caused by CIPN. It is imperative to note that a discussion with your doctor and your pharmacist should be had before taking anything. They would know best whether these supplements may interfere with your current treatment. Here’s a short list of supplements you can talk with your healthcare team about:
Alpha-lipoic acid is commonly used when people suffer from diabetic neuropathy. It is an antioxidant that helps fight ‘free radicals’ - molecules that can damage cells. It can help to relieve pain and tingling. Additionally, Evening primrose oil, another supplement commonly used for diabetics, is a source of essential fatty acids that are an important in protecting the membranes of nerve cells. It can also help to relieve pain and improve nerve functioning. This study suggests that they both have the potential to aid in symptom management of CIPN.
Omega-3 fatty acids, like eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are other essential fatty acids that our bodies do not create on our own but are beneficial to our health. They are known to be an essential part of the protection of our cell membranes which, in turn, helps protect nerve cells and decrease the risk of cell death. They are found in fish, fish oils, nuts, certain vegetables and flax seeds and can help protect against neuropathy from further damaging your nerve cells during chemo.
L-glutamine has several benefits to cancer patients including helping to prevent and reduce effects of neuropathy. L-glutamine is an amino acid that is essential in the production of proteins. It is not entirely known why it can be helpful in preventing neuropathy but it is speculated that it plays a “neuroprotective role, possibly due to the upregulation of nerve growth factor”.
The B6 vitamin, in low-doses, has been known to help aid in reducing neuropathy symptoms. It is said to play a role in helping your nervous system and if you are deficient in B6, taking extra may help to reduce your symptoms. Dana-Farber warns that higher doses may contribute to neuropathy so it’s especially important to discuss taking a B6 vitamin with your healthcare team first as is only beneficial if you are already lacking in this vitamin.
There are many vitamins and other supplements that may contribute to reducing your neuropathy pain. Speak to your healthcare team about what might be beneficial to you.
While there are no specific medications developed to treat neuropathy, there are over-the-counter and prescribed medications that may help reduce the effects of neuropathy. Mayo Clinic suggests pain relievers like non-steroidal anti-inflammatory drugs (NSAIDS) can help with mild symptoms. There are other medications such as anti-seizure and anti-depressants that can be prescribed to help relieve nerve pain.
There are topical medications that may help relieve nerve pain including capsaicin cream. Capsaicin is found in chili peppers and is often used to treat shingles pain because it eases affected nerves near the surface of your skin. Other topical creams like udder cream may also relieve your nerve pain. Many people have also found success with udder cream, a cream that was originally designed for cows until it’s benefits were found to be effective for people.
Changes to Treatment
While no one wants to change or adjust their treatments, you may find that it can help alleviate your symptoms. If your pain becoming unbearable and alternative options have not helped talk to your doctor about alternative treatments that may not affect you as much. People have also found success in simply changing the frequency and dosage of their chemo to lessen their symptoms.
If you are just beginning your treatment or are just starting to notice minor, yet manageable symptoms of neuropathy many of the above supplements and creams may help to protect you from future damage to your nerve cells. Cryotherapy – the use of cold temperatures to prevent damage to your cells - may also help in preventing neuropathy while you are receiving chemo. Similar to cold cap therapy (for the prevention of hair loss during chemo), frozen gloves or socks can decrease the blood flow in your hands and feet and therefore potentially reduce the toxicity caused by your chemotherapy.
Finding successful ways to prevent or manage your neuropathy symptoms can be a form of trial and error but there are lots of ways to help alleviate your pain. Talk with your doctor about what might work best for you.