Nerve Problems or Neuropathy

Approved by the Cancer.Net Editorial Board, 10/2018

Your nerves help you sense, feel, and move your body. Your nervous system has 2 parts: the central nervous system and the peripheral nervous system. The central nervous system is made up of your brain and spinal cord, a thick cord of nerves inside your spine. The peripheral nervous system is made up of all your other nerves. They send information between your brain and your body.

Doctors call damage to these nerves "peripheral neuropathy." It can cause problems related to sensing, feeling, and moving. Cancer or its treatment can cause peripheral neuropathy. Other causes include diabetes, thyroid problems, some inherited conditions, and not getting enough vitamin B12 or other nutrients. You can learn more about other possible causes at the end of this article.

Your specific problems depend on which nerves are affected. Peripheral neuropathy might cause some or all of these problems:

Changes in feeling, or sensation. This may include numbness, tingling, or pain. These are especially common in the hands and feet.
Muscle weakness
Constipation
Dizziness

Talk to your doctor if you have any of these problems. Cancer treatment might be the cause if you never had them before. But it is important to learn the cause, since it might also be a nutrition problem or a different disease.

Cancer and peripheral neuropathy (updated 07/2020)

You have some risk of peripheral neuropathy if you have cancer. Certain factors raise your risk of getting it from cancer or its treatment. These include:

Where the tumor is. A tumor might press on or grow into a nerve. This could cause nerve damage.

Some chemotherapy drugs. Some chemotherapy drugs can damage your nerves, especially in high doses. These include:

Bortezomib (Velcade)
Platinums, including cisplatin (Platinol), oxaliplatin (Eloxatin), and carboplatin (Paraplatin)
Taxanes, including docetaxel (Docefrez and Taxotere) and paclitaxel (Taxol)
Thalidomide (Synovir, Thalomid)
Vinca alkaloids, including vincristine (Vincasar), vinorelbine (Navelbine), and vinblastine (Velban)

Before cancer treatment begins, ask your doctor if your chemotherapy includes any drugs on this list. If so, talk with your doctor about your risk for developing peripheral neuropathy after receiving chemotherapy. This is especially important for people who already have neuropathy or who have conditions that may put them at greater risk for developing neuropathy, such as diabetes or a personal or family history of neuropathy.

ASCO does not recommend the use of the dietary supplement acetyl-L-carnitine or any other medication or supplement to prevent peripheral neuropathy caused by chemotherapy. Always talk with your doctor before taking any supplement or over-the-counter medication, because they can interact with cancer treatments.

Radiation therapy. Radiation therapy might damage nerves. It might be years before you notice signs of nerve damage.

Surgery. Lung or breast surgery can cause nerve problems. So can removing an arm or leg.

Cancer-related health problems. Problems called "paraneoplastic disorders" can cause nerve problems. They happen when your immune system reacts to nerve cells instead of cancer cells. This is more common in people with lung cancer.

Shingles is a virus that can cause nerve pain. It usually initially presents as a rash. It happens more often when your immune system is weak, which can be from cancer or its treatment.

If you have any nerve problems before you start cancer treatment, tell your doctor. Also tell them if you have diabetes, any inherited health conditions, nutrition problems, or other health concerns. The list below can help you think of other possible causes of nerve problems.

This information is based on ASCO recommendations for the Prevention and Management of Chemo-Induced Peripheral Neuropathy. Please note that this link takes you to another ASCO website.

Symptoms of nerve problems

Nerve problems, or neuropathy, are different for every person. Which problems you have and how serious they are depend on which nerves are damaged. It also depends on how many are affected.

You might have nerve problems during cancer treatment or a short time afterward. They might also get worse after your treatment ends.

Nerves that may be affected

You have 3 types of nerves that send messages to your brain and spinal cord. The information below tells you how nerve problems can affect each type.

Sensory nerves. These nerves affect your sense of feeling. Damage to the sensory nerves can cause the following problems in your hands and feet:

Tingling, burning, a buzzing “electric” feeling, or numbness. These symptoms usually start in the toes and then later in the tips of the fingers. They can continue along the hands and feet toward the center of the body.
Pain. This might feel like pinching, sharp stabs, a burning sensation, or electric shocks. Things like shoes or bed covers might cause pain, when they normally do not.
A tight feeling, as if you are wearing tight gloves or stockings.
Discomfort that gets worse when you touch something.
Difficulty feeling hot and cold temperatures or knowing if you hurt yourself.
Difficulty knowing where your hands and feet are in space. You might have difficulty walking or picking things up. It might be worse in a dark room or working with small objects.

Motor nerves. These nerves send information between your brain and your muscles. Damage to the motor nerves can cause the following problems:

Difficulty walking and moving.
Legs or arms that feel heavy or weak. You might have difficulty keeping your balance. Or you might have coordination problems.
Difficulty using your hands and arms. This can cause problems with everyday activities, such as texting or buttoning a shirt.
Muscle cramps in your hands or feet. The muscles might also get smaller.

Autonomic nerves. These nerves control the body functions you don’t have to think about. These include keeping your blood pressure, bladder, and bowels working normally. Damage to these nerves can cause the following problems.

Being unable to sweat normally
Digestive problems, such as diarrhea and constipation
Dizziness or lightheadedness
Trouble swallowing
Urinary problems
Sexual problems

Tell your health care team if you have any of these problems or notice changes in problems you have had for a while. If your nerve problems worsen, your health care team may lower the dose of your chemotherapy or change the schedule.

Coping with nerve problems

Managing symptoms, which can include nerve problems, is an important part of cancer care and treatment. This is called palliative care or supportive care. Talk with your health care team about any symptoms or side effects you or the person you are caring for experience. This is important to do both during your cancer treatment and after treatment is completed.

The right treatment for nerve problems depends on the cause, whether chemotherapy is completed, and your specific problems. You should know that these problems often go away a few months or years after treatment. But sometimes, they are long-lasting or permanent, so you need ways to make the best of your function and recovery.

Treatments for nerve problems (peripheral neuropathy) (updated 09/2022)

Medicines. Medicines can relieve pain. Your doctor might recommend non-prescription medicines if your pain is mild. These include pills you take by mouth and creams you put on the skin, depending on the type of nerve problems.

Your doctor might also prescribe medicines for you. For painful neuropathy related to previous chemotherapy, ASCO recommends the antidepressant duloxetine (Cymbalta).

You might take prescription medicines if the pain is severe. They might be anti-inflammatory drugs or painkillers. Prescription medicines can include pills you take by mouth and creams or patches you put on the skin, such as a lidocaine patch.

Medicines can relieve pain, but they do not help numbness.

Adjusting your chemotherapy treatment plan. If you develop peripheral neuropathy from ongoing chemotherapy that causes severe pain or affects your ability to function, your health care team may choose to give your doses of chemotherapy further apart, lower the amount of chemotherapy you’re receiving, or change your treatment plan. Talk with your doctor about what they recommend and if you can receive a treatment that does not cause peripheral neuropathy instead.

Better nutrition. Eating a diet that includes specific nutrients might help your nerve problems.For example, you might need more B vitamins, including B1, B12, and folic acid (folate). Or you might need more antioxidants. These are found in many fruits and vegetables.

Ask your doctor how much alcohol is safe to drink, if any. Also ask your doctor or health care team about a balanced diet. You might be able to meet with a nutrition specialist to make sure what you eat and drink is helping your nerve problems, not making them worse.

Physical or occupational therapy. You might work with a physical therapist to learn movements and balance exercises that help you cope with nerve problems. You might also work with an occupational therapist. This type of therapist helps you find ways to do daily and work activities, even with nerve problems. This might include using specific devices, such as a long pole to pick up items on the floor if you have poor balance. Your therapist might also recommend exercises or classes to help improve your balance and reduce pain.

Getting regular exercise might also help reduce pain. You might also try devices that stimulate the skin with electricity, including scrambler therapy and a transcutaneous electrical nerve stimulation (TENS) device. Or, you may talk with your doctor about trying cryotherapy, also called cold therapy. More research is needed, but they might help. Talk to your doctor before you start an exercise program or buy anything.

Acupuncture. Acupuncture can be used for many different problems, including peripheral neuropathy. This form of Chinese medicine involves inserting special needles into specific parts of the body. ASCO recommends that acupuncture may be offered to anyone experiencing chemotherapy-induced peripheral neuropathy.

Acupressure and reflexology are practices similar to acupuncture, but during these practices, the specialist uses their hands instead of needles to apply pressure to specific points on the body. ASCO recommends that acupressure or reflexology may be offered to anyone experiencing chemotherapy-induced peripheral neuropathy.

Ask your health care team for recommendations on acupuncturists or practices. If you are receiving acupuncture, make sure to see an experienced practitioner who only uses sterile needles and preferably has experience working with cancer patients so appropriate modifications are made for safety.

Other treatments. These integrative/complementary therapies might help reduce pain and mental stress:

Massage
Relaxation and mindfulness meditation

Ask your doctor if either of these might help you.

This information is based on ASCO recommendations for the Prevention and Management of Chemo-Induced Peripheral Neuropathy and the ASCO and Society for Integrative Oncology (SIO) joint guideline, “Integrative Medicine for Pain Management in Oncology.” Please note that these links take you to another ASCO website.

Staying safe at home

Having nerve problems, or peripheral neuropathy, raises your risk of hurting yourself, especially at home. These tips might help you avoid getting hurt.

Keep all rooms, hallways, and stairways well lit.
Put handrails on both sides of stairways.
Remove things you could slip or trip on, such as loose rugs or clutter.
Put grab bars and hand grips in your shower or tub. You might also put them next to the toilet. Put mats in the tub or shower so you do not slip. These should be rubber mats that stick to the floor.
Check the temperature of your hot water at home. Set your water heater's top temperature under 110 degrees Fahrenheit. This can help prevent burns if your nerve problems keep you from sensing heat normally.
Clean up spilled water or liquids right away, so you do not slip and fall.
Use dishes that do not break easily, in case you drop one.
Wear rubber gloves when you wash dishes. They help you get a better grip. Use pot holders when you cook, to protect your hands from heat.
Check how well you can feel the pedals and steering wheel of your car. Can you switch your foot quickly from the gas to the brake? If not, ask someone else to drive, or tell your doctor.
Ask your doctor if a cane or walker would help. If so, use it when moving between rooms.
Put cushioning mats in your home and work areas. They can make standing more comfortable.
Wear shoes with rocker soles. These are also called "rocker-bottom" soles. Many of these look like regular shoes, including fashionable shoes. Ask your doctor about the best shoes for staying safe and comfortable.