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Managing Chemo Induced Neuropathy

Steven Weinshel, MD, JD – Medical Co-Director Neurogenx NerveCenter of Sarasota
Board Certified in Neurological Surgery
Neurogenx Medical Advisor

Many patients receiving cancer treatment struggle with managing their chemo induced neuropathy.  Symptoms such as numbness, prickling, and increased skin sensitivity may be bothersome and some patients also experience severe pain, muscle weakness and other effects which may decrease quality of life.  If you have chemotherapy induced peripheral neuropathy (CIPN), here are some things you should know.

What is chemo induced neuropathy?

Certain types of chemotherapy medications are known to be “neurotoxic”.  While these medications are important in cancer treatment, over time they may damage the nerves and prevent them from functioning correctly.  Chemotherapy induced peripheral neuropathy occurs when sensory nerves in the extremities are damaged.

Symptoms of chemo induced neuropathy include abnormal sensations in the feet, legs or hands such as (prickling, burning or itching), loss of sensation in the feet and hands (numbness, cold sensation), and loss of motor function which may cause (clumsiness, loss of balance, frequently dropping things).  Some patients also experience severe pain which may be shooting or stabbing pains, extreme burning sensations, or cramping.

Chemo induced neuropathy is a common side effect of certain cancer medications.  Chemotherapy agents that are often associated with CIPN include: platinols (cisplatin, oxaliplatin, carboplatin), taxanes (paclitaxel, docetaxel) and vinca alkaloids (vincristine, vinorelbine).  Neuropathy may also be caused by other conditions including diabetes, shingles, and autoimmune disorders.

Managing chemo induced neuropathy

Treatment of neuropathy is aimed at relieving the symptoms or “palliative care”.  A combination of treatments may be tried to determine which works best for you.  These options may include:

  • Prescription medications such as antidepressants, opioid analgesics, sedatives, or anti-consultants.
  • Non-prescription analgesics or anti-inflammatories such as acetaminophen, ibuprofen and naproxen.
  • Topical treatments such as patches, creams and ointments used for muscle soreness and arthritis.
  • Nutritional support including a healthy diet high in B vitamins and antioxidants. Supplements may also be recommended.
  • Physical therapy or occupational to strengthen muscles, improve balance, and help with both large and fine motor coordination.
  • Massage therapy, acupuncture and relaxation techniques also help some patients.
  • Medical devices which use electrical stimulation on the skin to “distract” the nerves and reduce pain signals

Safety interventions

Your chemo induced peripheral neuropathy symptoms may increase your risk of injury.  Motor difficulties may increase your chance of a fall and numbness in the feet or hands may prevent you from noticing an injury once it occurs.   To help you prevent injury, you should:

  • Take care of your feet. Clean them daily and wear slippers or shoes both indoors and outside.
  • Make sure to check your shoes for irritants like small pebbles before you put them on.
  • Ensure that halls and walkways are well-lit and free of clutter and tripping hazards like rugs.
  • Install grab bars and non-skid surfaces in the bathing area
  • Make sure that your water heater is not too hot. If possible, adjust it to 110F or below.

Unfortunately, in most cases, once symptoms begin to occur, chemo induced neuropathy is irreversible and may continue to worsen.  If your chemo induced neuropathy symptoms are severe enough, a reduction or change in your chemotherapy may help.  You and your doctor must weigh the risks and benefits of your chemo regimen and work together to determine how well you are managing your chemo induced neuropathy.

Sources:
Chemocare http://chemocare.com/chemotherapy/side-effects/numbness-tingling.aspx
Dana Farber Cancer Institute http://www.dana-farber.org/Health-Library/Tips-for-Managing-Neuropathy.aspx

 

The Basics of Peripheral Neuropathy

The Basics of Peripheral Neuropathy

By Mark Shelly, DPM
Medical Director

Neurogenx NerveCenter of Encino

What is Peripheral Neuropathy?

Peripheral neuropathy (P.N.) is a medical diagnosis that describes damage to nerves and nerve endings, usually in the extremities, such as the feet and hands. P.N. can occur at any age and currently 20 million Americans suffer with the medical condition.

Peripheral neuropathy can result from many different things. The most common causes are:

  • Diabetes
  • Prescription Drugs – most commonly those involved with chemotherapy and HIV treatment
  • Toxins – including pesticides and solvents
  • Cancer
  • Alcohol
  • Chronic kidney disease
  • Chronic liver disease
  • Autoimmune disorders – such as Rheumatoid Arthritis, Lupus and Sjogrens
  • Trauma
  • Heredity
  • Nearly 30% of P.N. patients are described as idiopathic, which means the cause of neuropathy is unknown.

 

Older woman in pain

Symptoms of Peripheral Neuropathy

Peripheral neuropathy is a progressive problem, which means that it frequently starts with symptoms that are only moderately noticeable, but the symptoms gradually increase and get worse over time. The symptoms can include:

  • Tingling and numbness – especially in the hands or feet
  • Pins and needles sensations
  • Hypersensitivity
  • Burning, stabbing or shooting pain
  • Numbness in the feet or hands
  • A heavy feeling
  • The feeling of wearing tight socks or gloves
  • Or, as many patients have described to me – vague feeling of “something different” or “something stuck on my foot”
  • Cramping
  • Weakness

How is Peripheral Neuropathy Diagnosed?

Diagnosis neuropathy begins with a complete physical exam and usually includes:

  • Neurological assessment
  • Nerve biopsy/skin biopsy to observe the number of nerve endings
  • Electro-diagnostic tests such as a “nerve conduction velocity test” to evaluate how the nerves are functioning

Watch this space for future posts about available treatments as well as discussions of specific types of neuropathy.

Also, I would love to meet you at the 2017 Take Back Your Health Conference – coming up on April 8 & 9, 2017: www.takebackyourhealthconference.com

As part of the activities for this event, I also invite you to register to win a FREE TREATMENT COURSE: www.neurogenx.com/encino-giveaway

 

Neuropathy Of The Feet Success Story

The Spring edition of the Pinellas Health Care News a special article about Neurogenx patient George Potprocky, a career firefighter who retired to Florida. George had suffered for some time with a burning needle sensation in his feet that progressed to numbness.

“Once, I lost a nail and didn’t realize I lost it because I couldn’t feel it,” George recalls. “It was also hard for me to walk any distance. I’m part of a team that works on a racecar, and every time we’d go to the track, the other guys would walk up to the line. I’d take the scooter because I couldn’t walk that far. I finally said, I’ve got to do something about this.”

“After starting the Neurogenx treatments, I got more feeling back,” continued George. “Now, I can feel the floor when I walk; before, I couldn’t. My wife used to tell me my feet were cold, but I didn’t know they were cold. I can feel that now. I’ve already gotten back at least eighty percent of the feeling in my feet, and it keeps getting better.”

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Chemo Induced Neuropathy – Peripheral Neuropathy Caused by Chemotherapy

Chemo induced neuropathy can be a side effect of certain cancer treatment medications.  Chemotherapy induced peripheral neuropathy (CIPN) occurs when the sensory nerves of the feet, legs and arms are damaged by certain chemotherapy agents given to treat cancer.  CIPN is not as well-known as other chemo side effects but it can be debilitating.

What is chemo induced neuropathy?

Peripheral nerves normally work to detect and send signals about touch, temperature and movement from distant areas of the body such as the hands and feet.  Certain types of medication used to treat a variety of cancer may damage these nerves and result in chemo induced neuropathy.  If the nerves are damaged, they may no longer function correctly.   In some cases, nerve signals may become too frequent, may be “confused” or they may stop happening at all.

Chemo induced neuropathy is a common side effect for certain types of chemotherapy but it is not as well-known as others like hair loss and nausea.  Symptoms of chemo induced neuropathy include abnormal sensations, loss of sensation and motor symptoms.

  • Abnormal sensations – You may develop abnormal sensations in the feet, hands and other parts of the body. Sensations may include prickling or “pins and needles”, shooting or stabbing pains, unexplained itchiness and sudden or unusual extra-sensitivity.
  • Loss of sensation – You may lose some or all sensation in the hands, feet or other areas. This may appear as numbness, feeling of coldness when the skin is warm, or an inability to sense temperature.  If you cannot feel your skin, you may not notice an injury and should take care to avoid risks.
  • Motor symptoms – You may notice a loss of motor function when your body cannot sense its own movement or your muscles are not receiving the right signals. This may cause clumsiness, loss of balance, and decreased reflexes.  You may also notice that you frequently drop or cannot hold on to some items.

In some case, pain caused by chemotherapy induced peripheral nausea can be severe and may limit your ability to participate in day-to-day activities.  The stress of living with chemo induced neuropathy may also contribute to depression and emotional difficulties.

In addition to peripheral neuropathy symptoms, some patients also develop body-wide symptoms which can be serious.  Other symptoms of chemo induced neuropathy may include constipation, difficulty with urination, trouble swallowing and blood pressure changes.  Any of these symptoms should be reported to your doctor right away.

Medications

There are many kinds of oncology drugs, all of which have side effects.  Some of these medications are known to be “neurotoxic” and more likely to cause chemotherapy induced peripheral neuropathy than others.  Oncology medications most commonly associated with CIPN include:

  • Platinum-types – carboplatin, cisplatin, oxaliplatin
  • Vinca alkaloids – vincristine, vinblastine. vinorelbine
  • Taxanes – paclitaxel, docetaxel
  • Cytarabine
  • Ifosfamide

It may be difficult to tell if symptoms are chemo induced neuropathy or have been caused by your cancer or treatments like radiation.  Symptoms of neuropathy may also be caused by other conditions like diabetes, poor circulation, shingles, autoimmune disorders and other disorders.

Determining that your symptoms are caused by chemo induced neuropathy will be important in knowing how to treat your condition.

Sources:
American Cancer Society  https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/peripheral-neuropathy/symptoms-of-cipn.html
Cancer Network  http://www.cancernetwork.com/oncology-journal/chemotherapy-induced-peripheral-neuropathy