Peripheral neuropathy: Causes, symptoms and treatments

Many patients receive chemotherapy as part of their cancer treatment plan. These drugs have long shown benefits in extending patients’ lives, but they are also known for their side effects.

Chemotherapy-induced peripheral neuropathy is one of the most common side effects patients can experience. It can occur while a patient is receiving chemotherapy or after treatment is finished.

 There are many approaches to managing the discomfort of peripheral neuropathy. We spoke with Salahadin Abdi, M.D., Ph.D., to learn more.

What are the symptoms of peripheral neuropathy?

Patients can feel pain, numbness and tingling in a “glove and stocking” distribution. The most severe symptoms are typically experienced on the palm-side surfaces of the hands and the bottom surfaces of the feet. 

For some patients, neuropathy brings only mild discomfort, but others experience extreme changes that impact their balance, lead to trouble walking and cause sleepless nights. It negatively affects their quality of life.

What causes the pain of peripheral neuropathy?

Chemotherapy drugs work by clearing out any rapidly growing cells. Although they’re effective in wiping out cancer cells, they can also affect normal cells, which leads to side effects. 

Sometimes, the central nervous system is affected. This can cause some patients to experience confusion and forgetfulness. This is known as chemobrain. Other times, the nerves in the arms, legs, feet and hands are impacted. This leads to pain and/or tingling, burning or numbness in the limbs.

There are two things happening with the chemotherapy and the nerves. First, the chemotherapy can cause structural damage to the nerves.

Secondly, it can influence how the brain registers pain. When a patient has a nerve injury in the hands, feet, arms or legs, it’s translated into signals that travel to the patient’s brain to alert it that something’s wrong. This signal is what’s perceived as pain. Unfortunately, even if the nerves are structurally OK, they may function abnormally after chemotherapy, and the brain’s perception of nerve signals in the limbs can still be altered.  

How long does peripheral neuropathy last?

Some patients only experience symptoms of peripheral neuropathy for a short time while they’re receiving chemotherapy. Once the treatment stops, the nerves recover, and the neuropathy sensation goes away.

But many patients experience the feeling after they stop chemotherapy – sometimes years later.

How is peripheral neuropathy treated?

There are several medication options that can help reduce the pain and discomfort, but they can have side effects that can be just as disruptive as peripheral neuropathy.

Are there non-medication treatment options for peripheral neuropathy?

Yes. Some non-medication treatment options include acupuncture, acupressure, exercise or physical therapy intervention, neurofeedback therapy and cognitive-behavioral therapy.

Because so many patients experience peripheral neuropathy, there’s a lot of research being devoted to exploring effective treatments with fewer side effects. Three areas of alternative options include:  

• Scrambler therapy – Scrambler therapy mixes up the pain signals to only permit normal, non-pain signals to be transmitted to the brain. Electrode patches are placed on the skin around the area where the patient is experiencing pain. The patches are tethered to a machine that sends electrode pulses to the area to interfere with the pain signal, which then reduces the pain sensation the patient perceives. Overall, we’ve seen a significant increase in patients’ quality of life. Patients have reported experiencing less pain, and others have also had sensation return where they had previously had numbness. MD Anderson has been pivotal in studying scrambler therapy, but it’s still not as widely available as I’d like to see.
• Neurostimulators – Neurostimulators are in the early stages of investigation. These implanted devices deliver electric signals to interfere with pain signals. Historically, implanted electrodes have been placed around the spinal cord. A newer approach implants the electrodes at the root of the nerve known as the dorsal root ganglion that branches off from the spine. There are early signs that this placement may be more beneficial for some patients, but more research is needed.
• Cryotherapy – Another treatment called cryotherapy targets the extremities of the body with cold. With this approach, patients wear devices such as bracelets and ankle cuffs or gloves and socks that are designed to continuously circulate a cooling feeling to the arms, hands, legs and feet. However, there are risks and many patients don’t find much relief with cryotherapy. Some patients are sensitive to the cold, and their symptoms get worse.

What is your advice to patients experiencing chemotherapy-induced peripheral neuropathy?

Don’t hesitate to share what you’re experiencing with your care team. MD Anderson patients should speak with their doctor about our Pain Management Center. We have a multidisciplinary team that’s devoted to making our patients as comfortable as possible.    

But no matter where you’re getting your cancer treatment, it’s important to speak up about pain sooner rather than later. Don’t wait until your quality of life is really affected. Like any other disease, the earlier you start treatment, the better outcomes you’ll have. 

Request an appointment at MD Anderson online or by calling 1-877-632-6789.