Peripheral neuropathy
Peripheral neuropathy is damage to the nerves connecting the brain, spinal cord and the rest of the body. It can be caused by cancer or its treatment.
What is peripheral neuropathy?
Peripheral neuropathy is damage to the nerves that carry messages between the brain, the spinal cord and the rest of the body.
Different things can cause peripheral neuropathy, such as diabetes, injury, cancer and some cancer treatments. This information is about cancer-related causes of peripheral neuropathy.
For most people, the symptoms of cancer-related peripheral neuropathy will slowly improve when their cancer treatment has finished.
The nervous system
The nervous system has 2 main parts:
- the central nervous system (CNS) – which is made up of the brain and spinal cord
- the peripheral nervous system (PNS) – which is a network of nerves that carry messages between the brain, the spinal cord and the rest of the body.
The nervous system
What causes peripheral neuropathy?
There are different ways that cancer and its treatments can cause peripheral neuropathy:
- Some anti-cancer drugs can damage the nerves. This is the most common cause of peripheral neuropathy in people with cancer.
- If the tumour is growing close to a nerve and presses on it, this can cause peripheral neuropathy in 1 area of the body.
- Surgery may damage nerves and cause symptoms in the affected area. For example, breast cancer surgery may cause numbness or tingling and pain in the arm.
- Rarely, radiotherapy may damage nerves in the treated area. This can cause symptoms such as numbness and weakness. These symptoms may develop months or years after treatment.
- Rarely, in some cancers, the body may make substances that damage the peripheral nerves. This is called paraneoplastic syndrome. It may happen in people with lung cancer, myeloma or lymphoma.
Anti-cancer drugs and peripheral neuropathy
The anti-cancer drugs that most often cause peripheral neuropathy are:
- platinum-based chemotherapy drugs, such as cisplatin, carboplatin and oxaliplatin
- taxane chemotherapy drugs such as docetaxel, paclitaxel and cabazitaxel
- vinca alkaloid chemotherapy drugs such as vinblastine, vincristine and vinorelbine
- targeted therapy drugs such as thalidomide, lenalidomide and pomalidomide
- bortezomib – another type of targeted therapy.
You may be at a higher risk of developing peripheral neuropathy if you:
- are having more than 1 drug or treatment that can cause nerve damage
- have had anti-cancer drugs in the past that can cause peripheral neuropathy
- have diabetes
- have had nerve damage in the past – for example, if you have had sciatica.
Other things that may increase the risk of peripheral neuropathy include smoking and obesity.
If you need anti-cancer treatment, it is important to tell your doctor if you already have peripheral neuropathy. You should also tell them if you are worried about how peripheral neuropathy may affect you. You doctor will talk to you about the risks and benefits of any planned cancer treatment. There are anti-cancer drugs that do not cause peripheral neuropathy or make it worse.
Symptoms of peripheral neuropathy
The symptoms of peripheral neuropathy depend on the nerves affected. Symptoms are usually mild to start with. They can include:
- tingling, pins and needles or numbness in the affected area
- difficulty doing up buttons on clothing or picking up small objects
- a burning or warm feeling
- pain, which can be mild or more severe
- skin being very sensitive
- muscle weakness that makes it hard to walk, climb stairs or do other tasks
- constipation and feeling bloated if the nerves in the bowel have been damaged
- feeling light-headed or dizzy when you sit or stand up
- being less able to feel hot and cold
- problems with balance, walking and co-ordination.
Peripheral neuropathy caused by chemotherapy usually affects the hands, feet and lower legs.
Peripheral neuropathy may not affect you very much. But in some people, it can:
- cause pain
- affect their balance
- affect how well they can use their fingers to do tasks, such as picking up small objects or typing on a keyboard.
It is important to tell your healthcare team if you notice any new symptoms, or if your symptoms are getting worse. If you have nerve damage, it is better to diagnose it as early as possible.
Assessment
If you are having drugs that can cause peripheral neuropathy, your healthcare team will monitor you for signs of nerve damage before each treatment. Symptoms are often mild to start with and gradually get worse.
If you have symptoms of peripheral neuropathy, your cancer doctor will assess you to see how much your nerves are affected. This will help them decide whether to continue your treatment, reduce the dose or stop the drug.
Preventing peripheral neuropathy
No drug treatment has been shown to prevent or reverse nerve damage caused by anti-cancer drugs. Many different drugs have been studied but there is no evidence that they work.
Exercising while having chemotherapy treatment may help reduce the symptoms of peripheral neuropathy. Exercise can include aerobic exercise and exercises to help with balance. Talk to your cancer team about exercises that you could do during your treatment. They can advise you about what would be best for you.
Research is looking into cryotherapy to prevent peripheral neuropathy. Cryotherapy involves cooling the hands and feet before and during chemotherapy treatment. This can reduce the amount of drug that reaches these areas. The results of studies are encouraging, but more research is needed. You can ask your cancer team if this is available where you are having your treatment.
Managing peripheral neuropathy
Treatment for peripheral neuropathy involves preventing further damage to the nerves and managing the symptoms.
Your cancer doctor may lower the dose of the drug that is causing the problem. If your symptoms continue to get worse, they may stop using that drug.
It can be hard to stop treatment because of side effects, especially if the treatment is working well. Your doctors will discuss your treatment with you. They may suggest a different anti-cancer drug. Or they may discuss another type of treatment with you – for example, radiotherapy.
For most people, symptoms gradually improve once the drug is stopped, as the nerves slowly recover. This may take several months or longer. Symptoms may get worse for a few weeks before they start to get better. This is called coasting.
For some people, nerve damage will be permanent. But many people find ways of coping with the changes.
Treating pain
There are different ways to manage the nerve pain caused by peripheral neuropathy. Nerve pain is also called neuropathic pain.
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Drugs
A number of drugs can be used for nerve pain. A drug that has been shown to help is duloxetine. This drug is used to treat other conditions such as depression and anxiety. But it can also help with pain caused by peripheral neuropathy.
Other drugs that may help relieve nerve pain include gabapentin and pregabalin. These are also used to treat epilepsy. Other types of epilepsy drugs and anti-depressants can also be used to treat nerve pain.
There are also creams and patches that your doctor might prescribe to help with pain. These include menthol cream and capsaicin patches.
Painkillers that you can buy over the counter may sometimes help.
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Transcutaneous electrical nerve stimulation (TENS)
TENS is a way of managing pain using a mild electrical current.
A TENS machine is a small, battery-operated device. Wires from the TENS machine are attached to sticky pads that you put on the surface of your skin, near the area of pain. When you turn the machine on, it sends a small electrical current to the affected area. This causes a tingling sensation, which blocks pain signals being sent to the brain.
TENS is unlikely to cause any side effects. A physiotherapist or pain team can tell you whether TENS is suitable for you and how to use it. They may be able to lend you a TENS machine for a short time. If it works well for you, you can hire or buy one from a pharmacy or online.
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Pain teams
Many hospitals have pain teams. These are specialist doctors and nurses who are experts in managing pain. Your GP or hospital doctor can refer you to a pain team if your pain is difficult to manage.
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AcupunctureAcupuncture involves inserting very fine needles into the body at certain points called acupoints. It may be used to help manage different symptoms, including pain. There is some evidence to show that acupuncture can help with peripheral neuropathy.
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Psychological support
The pain from peripheral neuropathy can be hard to deal with. Things like anxiety and stress can make it worse. Getting support to help you manage your feelings can help make pain easier to cope with. Psychotherapists, counsellors and some pain teams can offer psychological support.
What else may help
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Exercise
Doing some physical exercise can help reduce symptoms. But it can be harder to exercise when you have nerve damage. A physiotherapist or exercise specialist can show you how to exercise safely. They can also show you exercises to help with walking, balance, muscle weakness and co-ordination.
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Occupational therapy
You can ask to be referred to an occupational therapist if you find it hard to do daily tasks such as washing or dressing. They can assess your needs and recommend aids and equipment to help you. There are also organisations that provide equipment.
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Benefits and financial help
If you have symptoms that cause problems with walking or daily activities, you may be entitled to financial help.
Personal Independence Payment (PIP) is a benefit for people who have problems with daily living or moving around and who live in England, Wales or Northern Ireland. You must have had these problems for 3 months and expect them to last for at least 9 months. If you live in Scotland, and have a disability or long-term health condition that affects your daily life, you may be able to claim Adult Disability Payment.
We have more information on financial help, benefits and work.
Things you can do
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Protect your hands and feet
If you have peripheral neuropathy in your hands or feet, it is important to protect them from injury:
- wear gloves and socks in cold weather to keep hands and feet warm
- wear gloves when working with your hands – for example, when gardening or washing up
- use oven gloves and take care to avoid burning your hands when cooking
- wear well-fitting shoes or boots
- do not walk around barefoot, and check your feet often to treat any scratches or other injury as soon as possible
- test the temperature of hot water with your elbow before baths, showers or doing the washing-up – you may want to turn the hot water temperature control (thermostat) to a lower setting or have a temperature control fitted.
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Prevent falls
If your balance, co-ordination or walking is affected, you may be more at risk of accidents and falls. To help prevent falls, you can try the following:
- Make sure rooms are well lit. Always put a light on if you get up during the night.
- Keep areas that you walk through (such as hallways) free of clutter. Remove things that you could trip over – for example, loose rugs.
- Make sure you have rails to hold on to on the stairs. You could add rails to the bath or shower.
- Get advice from a physiotherapist about walking aids if your balance is affected.
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Help with constipation
If you are having problems with constipation, it can help to:
- drink at least 2 litres (3½ pints) of fluids each day
- eat high-fibre foods, such as fruit, vegetables and wholemeal bread
- do regular gentle exercise, like going for short walks.
Your healthcare team can also give you advice. They may prescribe you drugs called laxatives to help.
Driving
If you live in England, Scotland or Wales, you need to contact the DVLA to tell them if you have peripheral neuropathy. They will advise you of any restrictions on your right to drive. Visit the DVLA's information about medical conditions, disabilities and driving, or call 0300 790 6806 for more information.
If you live in Northern Ireland, contact the Driver and Vehicle Agency (DVA) or call 0300 200 7861.
Your feelings
Peripheral neuropathy affects each person differently. It may not affect your life very much. But some people may have more symptoms and difficulties to manage.
It is natural to feel isolated and frustrated if your symptoms mean you have to make changes to your lifestyle. Everyone has their own way of coping. Some people find it helpful to talk to friends or family, while some get help from others. For example, it may help to share your experiences at a local cancer support group. Some people get support from online groups. Visit our Online Community where you can talk with others who understand what you are going through.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our ulcerating cancer wounds information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Loprinzi CL, Lacchetti C et al. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update. 2020. Journal of Clinical Oncology Volume 38. Number 38. Available from: doi.org/10.1200/JCO.20.01399 (accessed December 2023)
Suzuki K, Morishita S, et al. Neurological Outcomes of Chemotherapy-Induced Peripheral Neuropathy in Patients With Cancer: A Systematic Review and Meta-Analysis 2023. Integrative Cancer Therapies. 2023:22. Available from doi.org/10.1177/15347354231185110 (accessed December 2023)
Jordan B, Margulies A, et al. on behalf of ESMO Guidelines Committee. Systemic anticancer therapy-induced peripheral and central neurotoxicity: ESMO-EONS-EANO Clinical Practice Guidelines for diagnosis, prevention, treatment and follow-up. Ann Oncol. 2020 Oct;31(10):1306-1319. Available from doi: 10.1016/j.annonc.2020.07.003 (accessed December 2023)
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