Chemotherapy can damage nerves that affect feeling and movement in the hands and feet. Doctors call this condition chemotherapy-induced peripheral neuropathy (CIPN). Symptoms can be severe and may affect a person's quality of life.
A 2014 study of 90 people receiving chemotherapy found that about half had neuropathy, and 6.7 percent said it was a major symptom that doctors overlooked.
Doctors are unsure why some people have neuropathy, and others do not. The risk depends on the chemotherapy drug a person takes, which could be causing damage to the nerves.
In this article, we look at ways to prevent and treat CIPN, including natural and alternative remedies. We also list some of the chemotherapy drugs that cause CIPN and discuss symptoms and diagnosis.
Is CIPN preventable?
Symptoms of neuropathy can include pain, burning, and tingling in the hands and feet.
The best option for preventing neuropathy is by using a chemotherapy drug that is not likely to cause CIPN.
However, this is not always possible as cancer treatment is diagnosis-specific, which means the most effective drug may also be one that causes unpleasant side effects.
People should discuss their outlook and the risks and benefits of each treatment option with their doctor.
Some research suggests the following treatments might help prevent neuropathy:
- vitamin E
- calcium and magnesium
- anti-seizure drugs
- glutathione, a vitamin that is rich in antioxidants
Always talk to a doctor before trying any remedy to prevent CIPN.
Natural neuropathy remedies
Although there is no sure method for preventing CIPN, natural remedies may relieve symptoms.
It is essential to talk to a doctor before trying any natural remedy, even over-the-counter supplements that claim to be safe and natural, to make sure they do not interfere with treatment.
Some lotions may ease symptoms. People can try experimenting with mild creams that are unlikely to irritate the skin. Massaging painful areas with lotion may also help.
Some lotions to try include those that contain cocoa butter and menthol.
Exercise can increase blood flow to the hands and feet and may offer temporary relief from pain. One study showed that exercise improved symptoms, such as tingling and numbness in the hands and feet, in some people with breast cancer.
People should discuss the exercises that are best for them with their doctor. Low-impact activities, such as swimming, low-impact aerobics, or yoga, are the safest options.
Some research suggests that vitamin deficiencies may make CIPN worse.
Researchers are studying the possibility that certain vitamins or combinations of vitamins might help. However, a 2013 study in the journal Clinical Nutrition concludes that more research is necessary before doctors can recommend specific supplements.
A doctor can test a person's vitamin levels and make sure they are not deficient. Anyone who is lacking vitamins in their diet can take supplements following a recommendation from their doctor.
A healthful diet can help the body fight cancer more effectively and may also ease some side effects of treatment.
Research does not support a specific diet, but a healthful diet should focus on fruits and vegetables, lean proteins, and whole grains, as well as plenty of water.
If nausea caused by the chemotherapy makes it difficult to eat, people can talk to a doctor about nausea treatment options.
Massage can offer temporary relief from neuropathy symptoms.
Massage improves blood flow and may offer temporary relief from symptoms.
Some people may tense their muscles in response to neuropathic pain and massage can help release this tension, which may prevent the pain from radiating.
A study outlined at the 2016 Palliative Care in Oncology Symposium and reported in Oncology Nursing News noted that people who had CIPN as a result of treatment for multiple myeloma saw an improvement in their symptoms after massage therapy sessions.
Other alternative remedies
Some people find relief from acupuncture, reflexology, chiropractic, and other forms of alternative medicine. However, many of these treatments need further research to confirm their effectiveness.
These remedies may also help some people cope with the stress of facing a cancer diagnosis and dealing with chemotherapy.
Research has not conclusively proven that these remedies work, but many people who have cancer are willing to try non-traditional strategies for comfort and psychological well-being.
People should talk to their doctor before trying alternative remedies.
Medical treatments for neuropathy
No single medical treatment for neuropathy works for all or most people undergoing chemotherapy. Many treatments are still in the experimental stage.
The most effective treatment largely depends on the chemotherapy drug a person is taking. This is because different drugs damage different nerves.
Researchers are testing drugs to counteract the nerve damage that causes CIPN. Early research suggests some medications may help, depending on the chemotherapy drug a person uses.
However, a 2014 review from the journal Cancer Management and Research says current information on the effectiveness of these drugs is controversial and requires more study.
Neuromodulation works by training the brain to process nerve sensations differently. Though still experimental, the following treatments may help:
- neurofeedback, which conditions the brain to change the way it responds to pain
- scrambler therapy, which prevents injured nerves from sending signals to the brain
- repetitive transcranial magnetic stimulation, which uses magnetic pulses to encourage changes in the electrical activity in the brain
Adjusting chemotherapy dose
Medical treatments may not be effective for neuropathy, so the standard treatment of choice is to reduce the dose of chemotherapy.
A doctor may recommend more weekly treatments at half the dose or, in some cases, stopping chemotherapy.
Which chemo drugs cause neuropathy?
The drugs most likely to cause CIPN include:
Ringing in the ears is a common symptom of neuropathy.
Numbness and tingling in the hands and feet are the main symptoms of neuropathy.
Some people have weakness and find it difficult to hold small objects. Symptoms can be severe and significantly impact a person's quality of life.
Common symptoms include:
- pain in the hands and feet
- tingling or burning in the hands and feet
- shooting or electrical sensations in the hands, feet, or legs
- ringing in the ears
- difficulty picking up objects
- difficulty with tasks that require close control, such as buttoning a shirt
- very cold or hot hands or feet
- loss of balance
- painful or difficult urination
CIPN is particularly problematic to treat because it is not possible to predict when symptoms may occur — sometimes, they develop after treatment has ended — or how long they will last.
How is it diagnosed?
A doctor can usually diagnose neuropathy by looking at a person's symptoms, especially when they are taking one of the chemotherapy drugs that are known to cause neuropathy.
However, nerve pain may be due to something other than chemotherapy.
Other medical conditions that can cause neuropathy include:
- kidney failure
- autoimmune diseases
- carpal tunnel disorder
- alcohol abuse
- nutritional deficiencies
A doctor may conduct testing to rule out these other causes.
Outlook and takeaway
Neuropathy can be extremely painful, but it is not usually permanent. For most people, symptoms go away after they stop chemotherapy.
Sometimes it takes a few months for symptoms to fade. A 2014 study found that 30 percent of people still had symptoms of CIPN 6 months or longer after stopping chemotherapy.
In rare instances, neuropathy can be permanent, but there is no way to predict whether this will be the case. Although CIPN can be debilitating, it is important to keep in mind that symptoms almost always improve.