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.
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 includes the brain, the spinal cord and a network of nerves throughout the body. It has two main parts:
- the central nervous system (CNS), which is made up of the brain and spinal cord
- the peripheral nervous system (PNS), which is made up of nerves that carry messages between the brain, the spinal cord and the rest of the body.
There are different ways that cancer and its treatments can cause peripheral neuropathy:
- Some anti-cancer drugs can cause nerve damage. This is the most common cause of peripheral neuropathy in people with cancer.
- Cancer can cause peripheral neuropathy in one area of the body if the tumour is growing close to a nerve and presses on it.
- 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 may develop months or years after treatment.
- In some types of cancer, the body may make substances that damage peripheral nerves. This is called paraneoplastic syndrome. It may happen in people with lung cancer, myeloma or lymphoma.
The symptoms of peripheral neuropathy depend on which nerves are affected. Symptoms of peripheral neuropathy are usually mild to start with and gradually get worse.
Peripheral neuropathy usually affects the hands, feet and lower legs.
Symptoms may include:
- tingling, pins and needles or numbness in the affected area
- pain, which can be mild or more severe 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 up or stand up
- difficulty doing up buttons on clothing or picking up small objects
- problems with balance, walking and coordination.
It is important to tell your doctor if you notice any new symptoms that may be caused by treatment, or if your symptoms are getting worse. If you do have nerve damage, it is better if it is diagnosed as early as possible.
The anti-cancer drugs that most often cause peripheral neuropathy are:
- vinca alkaloids, which include vinblastine (Velbe®), vincristine (Oncovin®), vinorelbine and vindesine.
- platinum-based drugs, such as cisplatin, oxaliplatin and carboplatin.
- taxanes such as docetaxel and paclitaxel
- interferon alpha (Rofeon-A®).
You may be at a higher risk if you:
- are having more than one type of drug or treatment that can cause nerve damage
- have had anti-cancer drugs in the past that can cause peripheral neuropathy
- have diabetes
If you already have peripheral neuropathy and need to have anti-cancer treatment, talk to your doctor. There are anti-cancer drugs that do not cause peripheral neuropathy or make it worse.
If you are given drugs that can cause peripheral neuropathy, your doctor or nurse will monitor you for signs of nerve damage before each treatment. Symptoms are often mild to start with, and gradually get worse.
If an anti-cancer drug is causing peripheral neuropathy, your doctor will assess how much your nerves are affected. This helps them decide whether to continue your treatment, reduce the dose or stop the drug.
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. But at the moment, 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 and to manage the symptoms. 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 called 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 talk to you about whether another type of anti-cancer drug can be given instead. Or some other kind of treatment, such as radiotherapy, may be suggested. It is 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 change nerve impulses and help relieve nerve pain. Gabapentin (Neurontin®) and pregabalin (Lyrica®) are drugs that work in this way. They are also used to treat epilepsy. Other types of epilepsy drugs and anti-depressants are also used to treat nerve pain. Some people may worry that they are being given anti-depressants because the doctor thinks the pain is in their mind. But, anti-depressant drugs are given to people with peripheral neuropathy because of the way they act on nerves. Painkillers also sometimes help.
Transcutaneous electrical nerve stimulation (TENS)
A TENS machine is a small, battery-operated device that has cables connected to sticky pads. The pads go on the skin, and give off small electrical pulses. This causes a tingling sensation, which can stimulate nerves close to the painful area. It is thought that TENS 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 tell you whether TENS is suitable for you and how to use it. They may give you a TENS machine on a short-term loan so that you can find out if it is helpful.
Many hospitals have pain teams with specialist doctors and nurses who are experts in pain control. Your GP or hospital doctor can refer you to a pain team if your pain is difficult to control.
This may help reduce the anxiety, tension and fear caused by the pain, and make it easier to cope with. Psychotherapists, counsellors and some pain teams can offer psychological support.
In acupuncture, very fine needles are placed through the skin in certain areas of the body. It is thought that this may block pain messages that are sent to the brain. At the moment, there is not enough medical evidence to show that acupuncture improves peripheral neuropathy. But some people may find it helpful.
Other types of help
A physiotherapist can help if you are having problems with:
- muscle weakness
You can ask to be referred to an occupational therapist if you are finding it hard to do daily tasks because of peripheral neuropathy, such as washing or dressing. They can assess your needs and recommend appropriate aids and equipment to help you. There are also organisations that provide equipment.
Benefits and financial help
If you have symptoms for more than 6 months, and they cause problems with walking or daily activities, you may be entitled to financial help. You may be able to claim Disability Living Allowance if you are aged under 65 or Attendance Allowance if you are over 65. You can use the Macmillan Benefits Calculator to find out which benefits you may be entitled to.
Protect your hands and feet
If you have peripheral neuropathy in your hands or feet, it is important to protect them as much as possible. You can:
- keep them warm by wearing gloves and socks in cold weather
- 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
- avoid walking around barefoot, and check your feet often
- test the temperature of water with your elbow before baths, showers or doing the washing-up. Turn the temperature control (thermostat) to a lower setting for hot water, or have a temperature control fitted.
If your balance, coordination or walking is affected, you may be more at risk of accidents and falls. To help prevent falls, you can:
- make sure rooms are well lit and 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 (such as loose rugs) that you could trip over
- get advice from a physiotherapist about walking aids if your balance is affected.
Help with feeling lightheaded or dizzy
Your GP can give you advice if problems with your blood pressure are making you feel lightheaded or dizzy when you stand up. The following suggestions may also help:
- Ask your GP to prescribe you support stockings to wear during the day. These improve circulation and can help your symptoms.
- Do leg exercises before you stand up. You could try moving your feet up and down at the ankle. Or lifting your knees up and down as if you are marching.
- Stand up slowly, as this gives your body more time to adjust to the change in position.
- Drink plenty of fluids. Being dehydrated can make your symptoms worse.
- If you start feeling lightheaded or dizzy, stop what you are doing and sit down, or lie down if possible. Drink some water.
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.
You can also ask your doctor, specialist nurse or pharmacist for advice. They may prescribe you laxatives.
If you live in England, Scotland or Wales, you will 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.
Having peripheral neuropathy affects each person differently. You may find that your life is not affected very much, or you may have many more challenges and difficulties to cope with.
It is natural to feel isolated and frustrated if your symptoms cause 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. Sometimes it is helpful to share your experiences at a local cancer support group. Some people prefer to keep their feelings to themselves. You can also connect with people in our Online Community. The emotional support forum is a place to talk with others who understand what you are going through.
There is no right or wrong way to cope, but help is there if you need it.
Below is a sample of the sources used in our peripheral neuropathy information. If you would like more information about the sources we use, please contact us at email@example.com
Hanai. A et al. Effects of cryotherapy on objective and subjective symptoms of paclitaxel-induced neuropathy: Prospective self-controlled trial. JNCI: Journal of the National Cancer Institute, Volume 110, Issue 2, February 2018, Pages 141–148, /doi.org/10.1093/jnci/djx178. Accessed January 2020.
Brooks. K and Kessler. T. Treatments for neuropathic pain. The Pharmaceutical Journal. December 2017. Accessed January 2020. Available here: pharmaceutical-journal.com/article/research/treatments-for-neuropathic-pain
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. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
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