Nerve Problems or Peripheral Neuropathy

Approved by the Cancer.Net Editorial Board, 06/2023

Nerves are bundles of fibers in the body that help you sense, feel, and move. The nervous system is the name of the network that the nerves form.

There are 2 parts to the nervous system: the central nervous system and the peripheral nervous system. The central nervous system is made up of the brain and spinal cord, a thick cord of nerves inside the spine. All other nerves in the body are a part of the peripheral nervous system. Peripheral nerves send information between your brain and your body.

Nerve problems are called neuropathy. Damage to your nerves in the peripheral nervous system is called peripheral neuropathy. Neuropathy can cause problems related to sensing, feeling, and moving. The specific problems depend on which nerves are affected.

Cancer and cancer treatment can cause peripheral neuropathy. Treating and relieving side effects is an important part of cancer care and treatment. This is called palliative and supportive care. Talk with your health care team about any symptoms you have, including new symptoms or changes in your symptoms.

What are the symptoms of neuropathy?

Nerve problems are different for every person. The symptoms you experience and how serious they are depend on which nerves are damaged and how many are damaged.

There are 3 types of nerves that send messages to your brain and spinal cord: sensory nerves, motor nerves, and autonomic nerves. Symptoms will depend on the type of nerve that is affected.

Sensory nerves. These nerves affect your sense of feeling. Damage to sensory nerves can cause:

  • Tingling, burning, buzzing, or numbness

  • Pain that can feel like pinching, sharp stabs, burning, or electric shocks

  • Tightness

  • Discomfort that gets worse when you touch something

  • Difficulty feeling hot and cold or knowing if you hurt yourself

  • Problems knowing where your hands and feet are in space, causing difficulty walking or picking things up

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

  • Problems walking or moving

  • Legs or arms that feel heavy or weak

  • Balance and coordination problems

  • Difficulty using your hands and arms, making everyday activities like texting or buttoning a shirt a challenge

  • Muscle cramps

Autonomic nerves. These nerves control the body functions you do not have to think about. Damage to autonomic nerves can cause:

Talk to your health care team if you have any of these problems or notice changes in problems you have had for a while. If nerve problems worsen, your health care team may adjust your treatment.

Can chemotherapy damage nerves?

Some types of chemotherapy drugs can cause neuropathy. When chemotherapy causes neuropathy, it is called "chemotherapy-induced peripheral neuropathy" or CIPN. These drugs include:

  • Bortezomib (Velcade)

  • Platinum-based chemotherapy, 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 any of the drugs in your treatment plan can cause damage to the nerves. They can tell you your risk for developing neuropathy after receiving chemotherapy. This is an especially important step for people who already have neuropathy or who have conditions that may put them at greater risk of developing neuropathy, such as diabetes or a family history of nerve problems. See below for more examples of conditions other than cancer that can cause neuropathy.

The American Society of Clinical Oncology (ASCO) does not recommend the use of the dietary supplement acetyl-L-carnitine or any 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.

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

Other cancer-related causes of neuropathy

Other types of cancer treatment and cancer itself can damage nerves and cause neuropathy. Other cancer-related causes of neuropathy include:

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

Radiation therapy. Nerve damage caused by radiation therapy can begin quickly and get better, but most radiation-induced peripheral neuropathy takes months or years to cause problems and can worsen over time.

Surgery. Cuts made during surgery can damage nerves and cause neuropathy.

Cancer-related health problems. Sometimes, your immune system reacts to healthy cells instead of cancer cells. This is called a paraneoplastic disorder. When the immune system reacts to nerve cells instead of cancer cells, it can cause nerve problems.

What other conditions can cause neuropathy?

Sometimes, a condition other than cancer causes nerve problems. Or nerve problems you had before you developed cancer can be made worse by cancer and cancer treatment. Other conditions that can cause neuropathy include:

  • Diabetes

  • Drinking too much alcohol

  • HIV, the virus that causes AIDS

  • Autoimmune diseases, such as lupus or rheumatoid arthritis (RA)

  • Thyroid problems, especially low thyroid hormone levels, which is called hypothyroidism

  • Kidney problems

  • Certain inherited conditions that affect nerves

  • Lead poisoning or being exposed to pesticides

If you have had nerve problems in the past or if you have any of the conditions listed above, tell your doctor before cancer treatment begins. Learn more about managing your care when cancer is not your only health concern.

How is neuropathy treated?

The right treatment for nerve problems depends on the cause, whether chemotherapy treatment is finished, and your specific symptoms. Nerve problems often go away a few months or years after treatment. But sometimes, they are long-lasting or permanent. Your health care team can help you find the best ways to cope with your neuropathy.

Managing side effects such nerve problems is an important part of cancer care during and after treatment, called survivorship or follow-up care. Talk with your health care team about any symptoms or side effects you or the person you are caring for experience.

Treatments and strategies for coping with neuropathy include:

Medication. There are medications to relieve the pain from neuropathy. But pain medications do not relieve numbness related to neuropathy. Your doctor might first recommend non-prescription medication, called over the counter medication, if the pain is mild. These include pills that can be taken by mouth and creams you put on the skin, depending on the type of nerve problem.

There are also prescription medications that can help. For painful neuropathy related to previous chemotherapy, ASCO recommends the antidepressant duloxetine (Cymbalta). You may also be prescribed anti-inflammatory drugs or painkillers. Prescription medications can include pills you take by mouth and creams or patches you put on the skin, such as a lidocaine patch.

Adjusting your chemotherapy treatment plan. If you develop neuropathy from ongoing chemotherapy that causes severe pain or affects your ability to function, your health care team may adjust your chemotherapy treatment plan. This could mean giving chemotherapy doses further apart, lowering the amount of chemotherapy you receive, or changing the treatment plan in other ways.

Exercise. Exercise can help you cope with neuropathy by reducing pain and improving balance. However, the symptoms of nerve damage can make exercise challenging. Learn more about how to safely exercise when you have neuropathy.

Physical therapy. A physical therapist or cancer rehabilitation specialist can help you learn movements and balance exercises to help cope with nerve problems. These specialists may also help you use devices that stimulate the skin with electricity, including scrambler therapy and a transcutaneous electrical nerve stimulation (TENS) device. Cryotherapy, also called cold therapy, may also be an option. More research is needed into these techniques, but they might help. Always talk to your doctor, physical therapist, or cancer rehabilitation specialist before you start an exercise program or buy any devices to help with nerve problems.

Occupational therapy. You can also work with an occupational therapist. This type of therapist helps you find ways to safely do daily activities, even with nerve problems. This might include using specific devices, such as a long pole to pick up items on the floor if balance is a problem. Or, it could include helping you adjust your home to reduce your risk of falling. Learn more below about how to stay safe at home when you have neuropathy.

Nutrition. Eating a diet that includes specific nutrients may help some types of nerve problems. For example, there may be a need more B vitamins, including B1, B12, and folic acid (folate), or 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 other health care team members about eating a balanced diet. A registered dietitian nutritionist (RD/RDN) can help to make sure what you eat and drink is helping your nerve problems and not making them worse.

Acupuncture/acupressure. Acupuncture can be used for many different problems, including neuropathy. This form of Traditional Chinese Medicine involves inserting special needles into the 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 about practices and providers. If you are receiving acupuncture, make sure to see an experienced practitioner who only uses sterile needles and preferably has experience working with people with cancer.

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

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.

How to stay safe if you have neuropathy

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

Prevent falls

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

  • Put handrails on both sides of the stairway.

  • Remove things you could slip or trip on, such as loose rugs or clutter.

  • Put grab bars and hand grips in the shower, tub, and next to the toilet.

  • Stick rubber mats in the tub or shower so you do not slip.

  • Ask your doctor if a cane or walker would help.

Prevent burns or other injuries

  • Check the temperature of your hot water at home. Set your hot water heater's top temperature under 110 degrees Fahrenheit/43 degrees Celsius to prevent burns.

  • Clean up spilled liquids right away.

  • Use dishes that do not break easily.

  • Wear rubber gloves when you wash dishes for a better grip.

  • Use pot holders when you cook to protect your hands.

Other ways to help

  • 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 and let your doctor know.

  • Put cushioning mats in your home and work areas to 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 ones. They can help you stay safe and comfortable.

Questions to ask the health care team

Consider asking your health care team these questions about neuropathy:

  • Does my cancer or cancer treatment put me at risk for developing neuropathy?

  • Is neuropathy a common side effect of the chemotherapy treatment I will receive?

  • What signs of neuropathy should I watch for? Which ones should I tell you about right away?

  • Can you recommend a physical therapist, rehabilitation specialist, or occupational therapist who can help me manage neuropathy?

  • Can you recommend trained providers, such as a oncology dietitian, acupuncturist, or massage therapist, who can help me manage the symptoms of neuropathy?

  • How can I make my home safer if I am having trouble walking or with my balance?

  • Why is it important to protect my skin from burns and injury? What are ways to do this?

  • Could regular exercise help with my neuropathy? What exercises are safe for me to do?

Related Resources

Exercising with Peripheral Neuropathy: What People Diagnosed With Cancer Should Know

What is Cancer Rehabilitation

What Is Peripheral Neuropathy and How Can It Be Prevented or Treated?

Staying Safe and Active During Cancer Treatment

More Information

Foundation for Peripheral Neuropathy: What Is Peripheral Neuropathy

National Cancer Institute: Nerve Problems (Peripheral Neuropathy) and Cancer Treatment