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Managing Peripheral Neuropathy
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Peripheral Neuropathy
Peripheral neuropathy is numbness and tingling in the hands and feet as a result of peripheral nerve damage from cancer treatment. Damage to peripheral nerve cells, the cells responsible for sensation that carry information from the brain to other parts of the body, leads to peripheral neuropathy. Symptoms depend on which peripheral nerves are affected and may include pain, numbness, tingling, swelling, and muscle weakness in parts of the body.
Neuropathy is a side effect of some chemotherapy drugs. Certain drugs may damage the peripheral nerve cells, causing them to function incorrectly. Neuropathy is most common in the hands and feet; other parts of the body may also be affected.
There are two forms of neuropathy-acute (short lasting and sudden) and chronic (long lasting). Acute neuropathy is reversible and temporary in duration. Chronic neuropathy lasts much longer. Neuropathy may resolve within several weeks to several months, however there is a possibility of irreversible symptoms.
There are three different types of peripheral nerves that may be affected by peripheral neuropathy:
- Sensory nerves are nerves that help you feel pain, heat, cold and pressure. Damage to sensory nerves may cause tingling, numbness inability to feel hot or cold sensation, and inability to feel pain.
- Motor nerves are nerves that help your muscles to move. Damage to motor nerves may cause weak or achy muscles, muscles that twitch and cramp, and swallowing or breathing issues.
- Automatic nerves are nerves that control functions such as blood pressure, digestion, heart rate, temperature, and urination. Damage to automatic nerves may cause constipation and diarrhea, dizziness, sexual problems, sweating problems, and urination problems.
Risk Factors
A risk factor is any characteristic, behavior, or condition that increases your chances of developing a disease. Patients at greater risk of peripheral neuropathy are those with a preexsisting case of neuropathy from a condition such as:
Symptoms
During chemotherapy treatments, neuropathy symptoms may last long and occur often. Symptoms may begin after your first dose of chemotherapy and could continue beyond your last treatment. Be sure to tell your healthcare team if you experience any of the symptoms below, so that steps can be taken to ease the problem.Most people feel initial symptoms in their hands and feet, beginning with their fingers and toes. The most common symptoms include:
Numbness and tingling in fingers and toes or reduced sensation of touch
Burning sensation in hands and/or feet
Difficulty walking/ a loss of balance
Difficulty with your fingers-buttoning clothing, writing, tying shoes, etc.
Increased or decreased sensitivity to heat or cold
Prevention
Certain effects of neuropathy may be preventable if certain precautions are taken. Some helpful tips for protection include:
When facing hot or cold environments:
Try to avoid activities that require you to go outside in cold or hot weather.
If you have to go outside in cold weather, wear warm gloves and boots.
Wear gloves or use a handkerchief when touching metal objects, such as your car or mailbox, since these can be cold or hot to the touch.
Remember, flooring can be cold and roads and sidewalks can be hot, so wear socks and/or shoes on your feet.
When using water:
Wash your hands and bathe or shower with lukewarm water.
To protect your hands:
Wear gloves when washing dishes.
Use insulated potholders when cooking.
Wear gloves when gardening.
Check your hands and feet for any cuts, burns, or abrasions regularly to avoid infection.
To protect your feet:
Avoid standing for long periods of time.
Avoid wearing tight footwear.
Walk only short distances.
To prevent falls:
Move rugs out of your path so that 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.
Ask questions about pain medication and integrative medicine practice.
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.
Treatment
Your doctor may have to interrupt your chemotherapy if the symptoms become too severe. He/she may lower the dosage of the drug that is causing neuropathy to reduce the side effects. If the neuropathy continues to worsen, it may be necessary to discontinue the use of the drug.Treatments for peripheral neuropathy include the following:
Drugs
- Pain Relievers: Over-the-counter pain relievers such as acetaminophen and ibuprofen may help relieve the mild symptoms of sensory neuropathy. For more severe pain, your doctor may prescribe a stronger pain medication.
- Tricyclic Antidepressants These medications are most often used to relieve tingling, burning pain/ Antidepressants block the signals in your brain that cause you to feel pain. It is very important to understand that your medical team may prescribe antidepressants for pain relief, not because they think you are clinically depressed or that your pain is imagined. Many medications have alternative uses other than the one they were created for. Ask your doctor about the many side effects of this medication including insomnia and balance problems.
- Anticonvulsants: These anti-seizure medications may be used to treat the sharp, stabbing pains associated with sensory neuropathy.
- Lidocaine Patch/Cream: This treatment uses topical cream that is rubbed on the exterior of the painful area, or a patch which contains medication, is placed over it. It has proven effective for some cases of neuropathy.
- Opioid Analgesics: These powerful pain-killers, such as codeine or oxycodone, may be prescribed; however, they are associated with side effects.
- Topical Medicated Creams: Muscle creams that use heat and cooling agents may be applied to the affected area through massage.
Therapies
- Acupuncture: The relief may not be immediate upon the first treatment and may require further treatments.
- Occupational TherapyThis special therapy focuses on overcoming health obstacles to keep patients active in life. For example, there are work simplification techniques to keep patients participating at home and work.
- Physical TherapyThis is used to strengthen the weakened muscles through a range of motion exercises, stretching, and massage.
- Biofeedback: Through the use of a machine, you learn how to control body responses that reduce pain.
- Transcutaneous Electrical Nerve Stimulation (TENS): This therapy delivers small electrical impulses through electrodes placed on the skin to prevent pain signals from entering the brain.
- Hypnosis:This therapy uses suggestions intended to decrease the patient's perception of pain. It is most effective if the patient is willing and motivated.
Simple Approaches
- Relaxation: Deep breathing, visualization, yoga, and meditation may help you focus on good things and not the pain.
- Exercise:Physical activities like swimming and taking short walks will help stimulate the nerves and strengthen the muscles.
- Vitamin supplements, such as vitamin B-100: These vitamins may be effective in nerve recovery.
- Massage your hands and feet regularly to stimulate the muscles and nerves.
- Flexible Splints:These will offer support for your joints and help you balance.
- Lotions and Creams:Moisturizers help the skin stay healthy and keep from cracking or scraping easily.
Questions to Ask the Doctor
If you have a good understanding of your disease and can explain your condition back to your doctor, then you’re in good shape. Questions are your primary resource to gain a better understanding of your disease and enhance your quality of care. Well-thought-out questions can make all the difference and can help you get the most out of your appointments. Prepare for your visit with your health care team by making a list of questions like the ones that follow:
- 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?
