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Peripheral neuropathy (also called neuropathy) is a term used to describe damage to nerves that are outside the brain and spinal cord (peripheral nerves).
Peripheral neuropathy is not one specific disease. Many different conditions that can damage the peripheral nerves can cause it. This information is about cancer-related causes of peripheral neuropathy, which mainly involves neuropathy caused by anti-cancer drugs.
We hope it answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having your treatment.
The nervous system consists of the brain, the spinal cord and a network of nerves threaded throughout the body. It has two main parts:
Nerves carry impulses back and forth between the body and the brain. They are made up of nerve cells called neurons. Some neurons are very small, but others can be up to one metre (three feet) long. When a nerve ending is stimulated - for example, by heat, touch or vibration – it creates a tiny electrical pulse. This sends a signal along the nerve cell.
When it reaches the end of the cell, the signal triggers the release of chemicals. These carry the signal to the next nerve cell. In this way, messages can be sent from nerves anywhere in the body to the spinal cord and then up to the brain.
There are different types of nerves:
Autonomic nerves also control both the rate that food passes through our digestive tract (stomach and bowel) and how the bladder works.
There are several ways that cancer and its treatments can cause peripheral neuropathy:
The symptoms of peripheral neuropathy vary depending on which nerves are affected. Anti-cancer drugs that cause nerve damage are most likely to affect sensory nerves, but some can also affect the motor nerves and the autonomic nerves.
Peripheral neuropathy often affects the hands, feet and lower legs. This is because the longer a nerve is, the more vulnerable it is to injury. Nerves going to the hands, feet and lower legs are some of the longest in the body.
Symptoms of peripheral neuropathy are usually mild to begin with and gradually get worse.
You may have a feeling of heaviness, burning or pins and needles in the affected area. Alternatively, you may notice unusual sensations, such as a feeling of warmth or burning when touching something cold.
You may find that even the lightest touch or pressure in the affected area feels uncomfortable or painful.
This can be mild or more severe. The pain may be felt as sharp and stabbing or as a burning sensation, or it may feel like minor electric shocks. There are treatments to help relieve pain.
There may be a loss of sensitivity or feeling in the affected area. Often the feet and fingertips are the first places to be affected.
A muscle may lose strength if it isn’t being stimulated by a nerve. Depending on which muscles are affected, this may make it difficult to walk, climb stairs or do other tasks.
If the nerve endings in the fingers are affected, you may not be able to do ‘fiddly’ tasks, such as fastening small buttons or tying shoelaces.
You may find that you stumble or trip when walking; uneven surfaces may be particularly difficult. You may feel clumsy at times or you may feel that your body isn't doing what you want it to. Your sense of where things are around you may become less certain.
This can happen when the nerves that control the rate that food passes through the bowel (autonomic nerves) are affected. Let your doctor or nurse know if you're having these problems.
These symptoms are sometimes caused by a sudden drop in your blood pressure, known as postural hypotension. This can happen when the nerves that control blood pressure and heart rate (autonomic nerves) are damaged. Your doctor can see if this is the cause of your symptoms by checking your blood pressure when you're lying down and standing up.
There are many different anti-cancer drugs. The types that most frequently cause peripheral neuropathy are:
Other anti-cancer drugs that may cause peripheral neuropathy include thalidomide|, bortezomib (Velcade®)| and interferon alpha|.
You may be at a higher risk if you:
If you think your diet may be low in vitamins or minerals, or if you're concerned that you drink a lot of alcohol, talk to your doctor about whether you should take vitamin supplements. The supplements may help prevent or reduce nerve damage. It's important not to take high doses of vitamins or minerals without your doctor's knowledge, in case this interferes with how well your treatment works.
If you already have peripheral neuropathy and need to have anti-cancer treatment, there are a large number of anti-cancer drugs that don't cause or aggravate peripheral neuropathy. Your doctor can discuss the possible options with you.
If you're being given a drug that can cause peripheral neuropathy, your doctor will monitor you for signs of nerve damage before each treatment. Symptoms are often mild to begin with and gradually become more severe.
The earlier that nerve damage is detected, the better; so it's important to tell your doctor if you notice any new symptoms that may be caused by the treatment or if your symptoms are getting worse.
If an anti-cancer drug is causing peripheral neuropathy, your doctor will assess how much your nerves are affected. This information helps them decide whether to continue your treatment, reduce the dose or stop the drug.
There are various ways your doctor may assess your symptoms:
Other more specialised tests are also sometimes done:
These assess the number of nerve cells that are working and test the speed that your nerves send messages (an impulse).
This records the response of the nerve or muscle to an electrical impulse.
There isn't a treatment to prevent or reverse nerve damage caused by anti-cancer drugs. Studies are looking at various drug treatments to see if they can help protect against nerve damage during anti-cancer treatment. There are also studies looking into whether any treatments can reverse nerve damage that has occurred. At the moment, however, there isn’t enough evidence that any of these drugs work.
The most effective treatment for peripheral neuropathy is to prevent further damage to the nerves. Sometimes it can help to lower the dose of the drug that is causing the problem. If your symptoms continue to get worse, your doctors may have to stop the treatment.
For most people, symptoms gradually improve once the drug is stopped, but they can sometimes continue to get worse for a few weeks. This is known as coasting.
Stopping treatment because of symptoms can be very difficult for some people to accept, especially if the treatment is working well. Your doctors will usually discuss with you whether another type of anti-cancer drug can be given instead. Alternatively, some other kind of treatment such as radiotherapy| may be suggested. It is extremely important not to stop treatment without talking to your cancer specialist first.
Most people find that their symptoms gradually improve with time as the nerves slowly recover. This may take several months or more. For some people, nerve damage will be permanent. In this situation, however, many people find that their symptoms become less troublesome over time, as they adapt and find ways of coping with the changes.
If you have nerve pain, sometimes called neuropathic pain, this can be managed in a number of ways:
Some types of drugs can alter nerve impulses and help relieve nerve pain. Gabapentin (Neurontin®) and pregabalin (Lyrica®) are drugs that work in this way. They are also anticonvulsants (drugs used to treat epilepsy). Other anticonvulsants and antidepressants are also used to treat nerve pain. If your doctor suggests an antidepressant drug, such as amitriptyline, this is because of the way it acts on nerves, not because they think that the pain is just in your mind. Drugs such as morphine can also sometimes help.
This may help reduce pain. TENS uses pads, which are put on to the skin, that give off small electrical pulses. This causes a tingling sensation, which aims to stimulate nerves close to the painful area. It's thought that this may work by blocking pain messages from being carried along the nerves to the brain. TENS is unlikely to cause any side effects. Physiotherapists or pain teams can advise you on whether TENS is suitable for you and how to use it. They may be able to loan you a TENS machine on a short-term basis so that you can find out if it’s helpful.
Very fine needles are placed through the skin at particular points. It isn’t clear exactly how this works, but it may help block pain messages from being sent to the brain.
This may help reduce the anxiety, tension and fear caused by the pain, and support can make it feel more bearable. Psychological support can be offered by psychotherapists, counsellors and some pain teams.
Many hospitals have pain teams that have specialist doctors and nurses who advise on all aspects of pain control. Your GP or hospital doctor can refer you to a pain team if your pain is troublesome.
If your symptoms are mild, you may not need any additional help in managing them. However, if you have more troublesome symptoms, support is available to help you cope with them.
A physiotherapist will be able to offer treatment and advice if you're having problems with coordination, muscle weakness, balance or walking.
If you're having difficulty carrying out daily tasks because of peripheral neuropathy, you can ask to be referred to an occupational therapist. They can assess your needs and recommend appropriate aids and equipment to help you. There are organisations that
If symptoms continue for more than six months and cause you difficulty in walking or carrying out daily activities, you may be entitled to financial help. You may be able to claim Disability Living Allowance| if you're younger than 65 or Attendance Allowance| if you're older than 65.
For more details on benefits and financial support, look at our financial issues| section or talk to us|.
If your hands or feet are affected, it's important to protect them as much as possible:
If your balance, coordination or walking are affected, you may be more at risk of accidents and falls:
If you feel lightheaded or dizzy when you stand up, because of problems with your blood pressure (postural hypertension), your GP can give you advice. The following suggestions may also help:
How peripheral neuropathy affects each person, and how much practical and emotional support is needed to cope with it, varies from person to person. You may find that your life is not affected very much, or you may have many more challenges and difficulties to cope with.
It's natural to feel isolated and frustrated if your symptoms are severe and causing changes to your lifestyle. You may feel angry, resentful or anxious. These are all normal reactions and part of the process many people go through in trying to come to terms with side effects caused by their treatment.
The Neuropathy Trust| aims to ensure that patients, family, carers and healthcare providers receive the highest possible level of support, information and communication about peripheral neuropathy.
The British Pain Society| can provide a list of local pain clinics, and information on managing pain.
The British Red Cross Society |runs a lending service for equipment and gives practical information on nursing.
A free, impartial and confidential service offering information, advice and, in some cases, practical help. The DIAL UK| service is provided by people with direct experience of disability.
Assist UK| leads a network of Disabled Living Centres that provide information and advice about products that can increase disabled or older people's choices about how they live.
The Disabled Living Foundation| provides practical, up-to-date, unbiased information and advice on equipment to increase independence in daily activities.
This section has been compiled using information from a number of reliable sources, including:
With thanks to: Dr Dawn Storey, Clinical Scientist in Supportive Oncology; and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network|.
Content last reviewed: 1 January 2013
Next planned review: 2015
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.
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© Macmillan Cancer Support 2013
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