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The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on July 16, 2021.

Peripheral neuropathy

The nerves in your body allow you to feel, move and sense the world around you. Those that are part of your brain and spinal cord are called the central nervous system. All other nerves are part of the peripheral nervous system.

Sometimes when you have cancer, you may develop peripheral neuropathy from the cancer itself or from the treatment. This means there’s nerve damage. Cancer and cancer treatments aren’t the only cause of peripheral neuropathy. Other causes may include:

  • Alcohol abuse
  • Certain autoimmune disorders, such as lupus or rheumatoid arthritis
  • Diabetes
  • Human immunodeficiency virus (HIV)
  • Injuries to the spinal cord
  • Kidney problems
  • Lead poisoning or exposure to pesticides
  • Poor circulation
  • Shingles infection
  • Thyroid problems
  • Vitamin B deficiency

How cancer or cancer treatment may cause nerve damage

There are a few ways cancer or cancer treatment may cause peripheral neuropathy. One cause is the location of a tumor. It’s possible for a tumor to press on or grow into a nerve.

Another common cause is chemotherapy drugs. Some drugs associated with chemotherapy-induced peripheral neuropathy (CIPN) include:

  • Immunomodulatory therapies (IMiDs), such as thalidomide, lenalidomide and pomalidomide
  • Plant alkaloids, such as etoposide, vinblastine, vincristine and vinorelbine
  • Platinum drugs, such as cisplatin, carboplatin and oxaliplatin
  • Proteasome inhibitors, such as bortezomib, carfilzomib and ixazomib
  • Taxanes, such as cabazitaxel, docetaxel and paclitaxel

Ask your cancer care team if the chemotherapy drugs you’re receiving may cause chemotherapy-induced peripheral neuropathy.

Radiation therapy may also cause nerve damage. However, this may develop slowly, and it may take years before you notice it.

Another potential cause: certain types of cancer surgery, including lung or breast surgery or the removal of an arm or leg.

Finally, there are health issues associated with nerve damage that may occur when you have cancer. For example, shingles is more likely to occur if you have a weaker immune system, which may be associated with cancer or cancer treatment. Shingles may cause nerve pain and damage. Cancer-related paraneoplastic syndromes, an uncommon group of disorders, may spur the immune system to mistakenly attack cells in the nervous system. This is more common with breast, lung, lymphatic or ovarian cancers.

You should alert your care team if you’re experiencing peripheral neuropathy. If you haven’t had it before, you may think your cancer treatments are the cause. However, that isn’t always the case.

Symptoms of peripheral neuropathy

Peripheral neuropathy may feel different for everyone. It may range from pain to numbness. The symptoms of peripheral neuropathy that you have depend on the types of nerves that are damaged.

Autonomic nerves control your blood pressure, heart rate, digestion and urination, among other functions. Autonomic nerve damage symptoms include:

  • New onset constipation or diarrhea
  • Dizziness or lightheadedness
  • Sexual problems, such as erectile dysfunction
  • Trouble swallowing
  • Urinary problems, such as difficulty emptying your bladder

Motor nerves help your muscles function properly. Peripheral neuropathy symptoms associated with motor nerves include:

  • Achy or weak muscles, which may lead to falling easily or having trouble with tasks like buttoning shirts
  • Coordination problems
  • Difficulty walking
  • Muscle cramping or twitching

Sensory nerves help you feel sensations like pain, heat and cold. Peripheral neuropathy in the sensory nerves may cause the following symptoms:

  • Inability to feel cold or hot sensations
  • Inability to feel pain from an injury
  • Numbness or tingling in your feet or hands
  • Pain that may feel like burning, pinching or sharp stabbing
  • Problems walking or picking things up, especially in the dark

How to manage peripheral neuropathy

Make sure to ask your cancer care team about how to best treat your peripheral neuropathy. This should be part of the supportive care for your cancer. The exact treatments depend on the cause.

Below are a few common ways to treat peripheral neuropathy.

  • Medications: It’s possible to start your treatment for nerve problems with over-the-counter pain relievers. If that doesn’t help, you may be prescribed anti-inflammatory medications or painkillers. Some of these are pills, while others are creams and patches. Antidepressants (in a smaller dose than what’s used for depression) or anti-seizure medications may be recommended to help with pain.
  • Changes to chemotherapy treatment: If you experience CIPN, your care team may be able to change the chemotherapy dose or frequency to help lessen your symptoms.
  • Changes in nutrition: Your dietitian may advise consuming more foods with B vitamins, including B1, B12 and folic acid. A review study published in October 2017 in Current Oncology Reports found that B vitamins may help prevent peripheral neuropathy—but there was no conclusive evidence that it may treat this problem.
  • Physical or occupational therapy: It’s possible to help your nerve problems with certain balance exercises and movements, and that is what a physical therapist may help you do. An occupational therapist helps show you better ways to complete daily tasks when you’re living with peripheral neuropathy.
  • Exercise: Regular physical activity may help reduce pain from peripheral neuropathy. But ask your care team before starting a new exercise program.
  • Integrative therapies, such as acupuncture or massage: Acupuncturists use small needles to stimulate points of the body. It’s often used to help cancer-related pain.

Living with peripheral neuropathy

There are several ways you may learn to live better with peripheral neuropathy and stay safe.

  • Avoid alcohol. This may cause further nerve damage.
  • Do your best to control your blood sugar if you have diabetes. Poor diabetes control is associated with a higher risk for peripheral neuropathy.
  • Set up your home to help prevent falls. Nerve problems may raise your risk for falling. Some changes to make your home safer include:
    • Adding bath mats in the shower or tub, and handrails to the bathroom and alongside stairways
    • Keeping hallways and stairs adequately lighted
    • Removing rugs or clutter that may be a fall hazard
    • Using dishes that don’t easily break
  • Closely monitor your hands and feet. If you have nerve problems that cause numbness, you could get an injury and not be aware of it until it’s more severe. Every day, examine your arms and feet for cuts and scratches. Wear shoes inside and outside to help lower your risk for injuries.
  • Monitor the temperature of the hot water in your home, including bath water. If you lack sensation, you may get burned and not know it. Setting your water heater’s maximum temperature to under 110 degrees Fahrenheit may help lower this risk.

Peripheral neuropathy may go away on its own after cancer treatment, or it may remain a permanent part of your life. Working with your cancer care team to help treat and manage it may help you cope.

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