Neuropathy

The Issue

The term neuropathy refers to issues with our nerves and can involve a wide range of symptoms such as tingling, burning, numbness, weakness, pain, or temperature sensitivity, mostly in the arms and legs. While there are a lot of different types of chemotherapies that can impact our nerves and cause neuropathy, some are more notorious than others (like taxane therapy).

The impact of neuropathy can be so disruptive that some people have to switch chemotherapy, while other people might experience neuropathy after chemotherapy is already completed. Because of this, you might have heard of strategies to reduce the impact of neuropathy during treatment (like cold mittens), or certain medications that are effective once treatment is over.

Here we will mostly focus on ways to approach neuropathy after cancer treatment, and how to feel empowered to take on this really bothersome side effect. At OncoveryCare, we know how impactful this can be. Even when neuropathy is referred to as "mild", it can still be a big deal and affect your well-being or ability to complete daily activities.

Furthermore, it’s important to identify neuropathy early and treat it because living with neuropathy can contribute to anxiety or depression, challenges with thinking or sleep, and/or movement and balance issues. While this may sound grim, we’re encouraged by the fact that for most survivors, neuropathy does improve with time after treatment.

Also, ideally we can address neuropathy before it leads to any other issues in your life, which is why we recommend taking action early and trying out different approaches. If you are experiencing neuropathy, keep reading. There are a number of helpful strategies to experiment with, and we are here to support you while you figure out what works for you and your symptoms.

Why does this happen?

While the exact causes of neuropathy are unknown, we do know that some types of chemotherapy or targeted therapies can damage the protective structure of the cells in the nervous system. This impacts our body’s ability to send signals to communicate pain, temperature, and muscle movement.

A good analogy is to imagine your body is like a house, and the nerves are the electrical wiring that runs through it, carrying signals to different rooms. Let’s say there is an issue with the wiring in the house—like it’s been damaged or frayed.

This can cause problems with the flow of electricity, just like neuropathy affects the communication signals in your body. The cells in our nervous system are like the wiring in this house, and any damage can impact the electric nerve fibers that communicate pain, temperature, and sensation in your body.

For many patients, neuropathy caused by treatment generally will improve with time, but unfortunately for some it can become long lasting so read on for how to take action!

Take Action!

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Get Checked Out:

• While your neuropathy may be caused by chemotherapy, it’s really important to make sure there isn’t anything else that can be contributing to your symptoms. This includes other common causes of neuropathy such as diabetes or vitamin deficiency. A basic set of blood tests can rule out these conditions. It’s also important to note that high levels of alcohol can cause or contribute to symptoms of neuropathy.

Exercise and Weight Management:

• Exercise, including both weight-bearing and aerobic exercise, can often help with symptoms of neuropathy. This is potentially because exercise increases blood flow and reduces inflammation which can be helpful. Similarly, weight management can help with symptoms of neuropathy.

Acupuncture:

• Some small studies have shown that acupuncture can improve neuropathy for some survivors who have mild to moderate symptoms. Typically this requires more than one treatment: for example, participants in one of the strongest studies received acupuncture for 8 weeks.

Supplements and natural products:

• Some survivors have found that supplements such as multivitamins can improve their symptoms of neuropathy. Unfortunately there is limited evidence to support their widespread use for treating neuropathy. Always check with your medical team before adding any supplements to your routine.

Massages:

• While studies have not shown massage to be universally effective in treating neuropathy (but wouldn’t it be nice?), there are many case reports that show improvements in neuropathy with massages targeted towards affected areas of the body like the hands and feet.

Medication:

• The medication with the most evidence of benefit for treating neuropathy is duloxetine. It is also used to treat depression and anxiety in some patients. Duloxetine is however associated with potential side effects (nausea, constipation, dry mouth) and can be expensive. Talking with your care provider about your specific symptoms can help determine if medication is right for you. Alternatively if the idea of a medication sounds overwhelming or unappealing, you could try a topical cream like low concentration menthol cream, though there is less evidence on how helpful this may be.

Therapy:

• Research indicates that learning and utilizing mindfulness skills, such as relaxation techniques, can be very effective in alleviating symptoms of neuropathy. Integrating mental health into your survivorship care plan is a powerful compliment to your physical health interventions.

In summary, we know neuropathy is a common challenge for survivors after chemotherapy, and both preventing and treating neuropathy can be tough. Trying some of the strategies above and talking with your care team can hopefully help you find the right management.

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