Peripheral Neuropathy

Approved by the Cancer.Net Editorial Board, 05/2017

The central nervous system includes the brain and spinal cord. Peripheral nerves are located outside the brain and spinal cord. They carry information between your central nervous system and the rest of the body.

Peripheral neuropathy is damage to the peripheral nervous system. Symptoms depend on which nerves are affected.

Examples of peripheral neuropathy symptoms:

  • A change in sensation, especially in the hands and feet. Sensations may include numbness, tingling, or pain.

  • Muscle weakness, called myopathy.

  • A change in organ function, resulting in constipation or dizziness.

Potential causes of peripheral neuropathy:

  • Disease, such as cancer, diabetes, or a thyroid disorder.

  • Nutrition problems, such as too little vitamin B12.

  • Inherited conditions, such as Charcot-Marie-Tooth disease.

Cancer treatment may also cause this disorder or make it worse.

Cancer-related risk factors

Peripheral neuropathy is a relatively common side effect. Anyone diagnosed with cancer is at risk for this condition. These factors can increase the risk:

Tumor location. A tumor may press on or grow into a peripheral nerve. This may damage it.

Chemotherapy. Specific types of chemotherapy can injure peripheral nerves, particularly high-dose chemotherapy. These include:

  • Bortezomib (Velcade)

  • Platinums, including cisplatin (Platinol), oxaliplatin (Eloxatin), and carboplatin (Paraplatin)

  • Taxanes, including docetaxel (Docefrez, Taxotere) and paclitaxel (Taxol)

  • Thalidomide (Synovir, Thalomid)

  • Vinca alkaloids, including vincristine (Vincasar), vinorelbine (Navelbine), and vinblastine (Velban)

Radiation therapy. Radiation therapy may damage nerves. Symptoms may take years to appear.

Surgery. Lung or breast surgery may lead to neuropathy. The surgical removal of an arm or leg, called amputation may also cause it.

Cancer-related disorders. Paraneoplastic disorders and shingles may cause neuropathy. Paraneoplastic disorders are rare. They arise when the immune system reacts to nerve cells instead of cancer cells. These disorders are more common in people with lung cancer. Meanwhile, shingles is a viral infection. It often causes pain and a rash in people with weakened immune systems.

Tell your health care team if you have neuropathy symptoms before treatment. Discuss other risk factors that you may have.

Other risk factors

These preexisting conditions may cause neuropathy:

  • Diabetes

  • Alcohol abuse

  • Infections, such as HIV/AIDS

  • Autoimmune diseases, such as lupus and rheumatoid arthritis

  • Hypothyroidism (an underactive thyroid)

  • Kidney disease or kidney failure

  • Hereditary peripheral neuropathy conditions, such as Charcot-Marie-Tooth disease

  • Lead poisoning or exposure to pesticides

Symptoms

Neuropathy is different for every person. The symptoms and their severity depend on which nerves are damaged andhow many nerves are affected.

Symptoms may develop during or shortly after cancer treatment. Neuropathy may also develop slowly or worsen after treatment has ended. This occurs most commonly with platinum drugs and drugs called taxanes.

Damage may occur in the 3 types of peripheral nerves:

Sensory nerves. These affect your sense of feeling.

Symptoms in hands and feet when sensory nerves are affected:

  • Tingling, burning, a buzzing “electricity” sensation, or numbness. It usually starts in the toes and fingers. It can continue along the hands and feet toward the center of the body.

  • Pain, usually described as pinching, sharp stabs, burning, and electrical shocks.

  • A feeling like wearing tight gloves or stockings.

  • An uncomfortable sensation that may get worse when you touch something.

  • Pain from objects that aren’t usually painful. For example, shoes or bedcovers.

  • Difficulty feeling hot and cold temperatures or knowing if you've injured yourself.

  • Difficulty knowing where your feet and hands are in space. This is called loss of position sense. It may make walking or picking up objects more difficult, particularly in a dark room or when working with small objects.

Motor nerves. Motor nerves send information between your brain and muscles.

Injured motor nerves may cause these symptoms:

  • Trouble walking and moving.

  • A feeling of heaviness or weakness in the legs and arms. This may cause balance and coordination problems.

  • Difficulty using the hands and arms.

  • Trouble with everyday tasks. Particularly fine motor skills, such as texting or buttoning a shirt.

  • Muscle cramps and muscle loss in the hands and feet.

Autonomic nerves. These nerves control the body functions you don’t control consciously. These include blood pressure and bowel and bladder function.

These symptoms may occur with damage to autonomic nerves:

  • An inability to sweat normally

  • Gastrointestinal problems, such as diarrhea and constipation

  • Dizziness or lightheadedness

  • Trouble swallowing

  • Sexual problems

Talk with your health care team about your symptoms. Include new ones and changes in symptoms. Ask about strategies to manage them.

Managing neuropathy

Relieving side effects is an important part of cancer care. This is called palliative care or supportive care.

Treatment for peripheral neuropathy depends on the cause and symptoms. Many people fully recover a few months or years after treatment. However, sometimes, the condition requires long-term management.

Peripheral neuropathy treatment options:

Medication. Although medication cannot cure neuropathy, it may relieve the pain. However, it doesn’t relieve numbness.

For neuropathy pain, doctors commonly prescribe anticonvulsants and antidepressants. For neuropathy related to chemotherapy, ASCO recommends the antidepressant duloxetine (Cymbalta).

Prescription nonsteroidal anti-inflammatory drugs or analgesics are options for severe pain. Analgesics are very strong painkillers. Topical treatments may also help control pain. These include lidocaine patches and creams. Topical 1% menthol also seems helpful, based on early studies.

Additionally, your health care team may recommend over-the-counter medications for mild pain.

Better nutrition. Eating a diet rich in specific nutrients may help manage neuropathy. Examples:

  • B vitamins, including B1 and B12

  • Folic acid

  • Antioxidants

Also try to eat a balanced diet. Avoid drinking too much alcohol.

Physical or occupational therapy. Physical or occupational therapy helps keep muscles strong. It also improves coordination and balance.

Therapists sometimes recommend devices that help with daily activities. Mind-body exercises, such as tai chi or qigong, can help improve balance.

Additionally, regular exercise may help reduce pain. Devices that stimulate the skin with electricity may help, too. However, more research is needed.

Integrative medicine. These complementary therapies may help reduce pain and mental stress:

  • Massage

  • Acupuncture

  • Relaxation

Safety at home

Peripheral neuropathy increases your chances of hurting yourself, especially at home. These tips may help you avoid injury:

  • Keep all rooms, hallways, and stairways well lit.

  • Install handrails on both sides of stairways.

  • Remove tripping and slipping hazards, like area rugs and clutter.

  • Install grab bars in the shower or handgrips in the tub. Place skid-free mats in the tub.

  • Make sure your shower or bathwater is below 110 degrees Fahrenheit to avoid accidental burn. This is in case you can’t sense hot temperatures as well. Use a thermometer to check the temperature and set your water heater at a lower temperature.

  • Clean up spilled water or liquids immediately.

  • Use non-breakable dishes.

  • Use potholders while cooking and rubber gloves when washing dishes.

  • Check how well you can feel your car’s navigational devices. These include the gas and brake pedals and steering wheel. Check whether you can quickly transition from the gas to the brake.

  • Ask if your doctor recommends a cane or walker. If so, use it when moving between rooms.

  • Place stress mats in your home and work spaces to cushion your feet.

  • Wear shoes with a rocker-bottom sole.

Related Resources

Nervous System Side Effects

Rehabilitation

Spotlight On: Physical Therapists in Oncology

More Information

Foundation for Peripheral Neuropathy: What Is Peripheral Neuropathy

LIVESTRONG: Neuropathy