Image by Kharlia Beck
Peripheral neuropathy is one of the major adverse effects of cancer treatment. It is known as CIPN or Chemotherapy Induced Peripheral Neuropathy. It varies in ranges of effects and time of occurrence. Sometimes it occurs during treatment, while other times it can be a long-term adverse effect. However, once acquired, it may not improve and in some cases worsen as time progresses away from the treatment. CIPN can also prove a barrier to physical activity, making exercise more challenging for survivors. For this reason, it is best to prevent it, and if that cannot be done, preventing it from worsening and affecting long-term quality of life. Thus, it is imperative to understand the causative agents, early symptoms and then take steps to reduce them. the peripheral nervous system (PNS), which is made up of nerves that carry messages between the brain, the spinal cord and the rest of the body.
What causes peripheral neuropathy?
There are different ways that cancer and its treatments can cause peripheral neuropathy:
Some anti-cancer drugs can cause nerve damage. This is the most common cause of peripheral neuropathy in people with cancer.
Cancer can cause peripheral neuropathy in one area of the body if the tumour is growing close to a nerve and presses on it.
Surgery may damage nerves and cause symptoms in the affected area. For example, breast cancer surgery may cause numbness or tingling and pain in the arm.
Rarely, radiotherapy may damage nerves in the treated area. This can cause symptoms such as numbness and weakness. These may develop months or years after treatment.
In some types of cancer, the body may make substances that damage peripheral nerves. This is called paraneoplastic syndrome. It may happen in people with lung cancer, myeloma or lymphoma.
There are certain chemotherapy drugs that have a greater tendency to cause CIPN, including the taxanes & vinka alkaloids amongst others. Oxaliplatin causes an acute neuropathy in which there is a cold sensitivity, throat discomfort, discomfort upon swallowing cold liquids and muscle cramps. These symptoms can occur starting with infusion, with the severity peaking at 2 to 3 days after dose and each subsequent cycle. Paclitaxel on the other hand, causes a pain syndrome in the days following each dose.
The primary approach is prevention. Cold caps, cold mitts and cold socks are often used to reduce circulation to the extremities and to prevent the cytotoxic agents damaging the nerve endings. Some centres have them and some do not. So, if the treating centre does not provide them, then you may want to source them yourself. These can be sourced from Amazon.com.au. Inform your clinical team of any neuropathic symptoms.
- tingling, pins and needles or numbness in the affected area
- pain, which can be mild or more severe
- muscle weakness that makes it hard to walk, climb stairs or do other tasks
- constipation and feeling bloated, if the nerves in the bowel have been damaged
- feeling light-headed or dizzy when you sit up or stand up
- difficulty doing up buttons on clothing or picking up small objects
- problems with balance, walking and coordination.
Things you can do: Protect your hands and feet – If you have peripheral neuropathy in your hands or feet, it is important to protect them as much as possible. You can:
- keep them warm by wearing gloves and socks in cold weather
- wear gloves when working with your hands – for example, when gardening or washing up
- use oven gloves and take care to avoid burning your hands when cooking
- wear well-fitting shoes or boots
- avoid walking around barefoot, and check your feet often
- test the temperature of water with your elbow before baths, showers or doing the washing-up. Turn the temperature control (thermostat) to a lower setting for hot water or have a temperature control fitted.
For established CINP, duloxetine is the only agent with evidence-based research and limited benefit to manage established painful CIPN. Other methods of management include exercise, falls reduction risk and protection of hand and feet (Cancer Council; EviQ, 2023). For long-term chronic management of PICN, please ask your treating team, GP, nurse practitioner, physiotherapist, exercise physiologist, occupational therapist, podiatrist, and psychologist (Cancer Council)
If you have nerve pain, sometimes called neuropathic pain, this can be managed in a few ways. Some types of drugs can change nerve impulses and help relieve nerve pain. Gabapentin and pregabalin (Lyrica®) are drugs that work in this way. They are also used to treat epilepsy. Other types of epilepsy drugs and anti-depressants are also used to treat nerve pain.
Transcutaneous electrical nerve stimulation (TENS)
A TENS machine is a small, battery-operated device that has cables connected to sticky pads. The pads go on the skin, and give off small electrical pulses. This causes a tingling sensation, which can stimulate nerves close to the painful area. It is thought that TENS may work by blocking pain messages from being carried along the nerves to the brain. TENS is unlikely to cause any side effects. Physiotherapists or pain teams can tell you whether TENS is suitable for you and how to use it. They may give you a TENS machine on a short-term loan so that you can find out if it is helpful.
Acupuncture – In acupuncture, very fine needles are placed through the skin in certain areas of the body. It is thought that this may block pain messages that are sent to the brain. Now, there is not enough medical evidence to show that acupuncture improves peripheral neuropathy. But some people may find it helpful. Physiotherapy to improve balance and muscle weakness . Psychology can help also to address the tension and anxiety pain can cause.
Understanding Peripheral Neuropathy – Take a look at this information from Cancer Council.
References
Amazon Australia. (2025). Cold caps, cold mitts and cold socks. Accessed May 29, 2025, from https://www.amazon.com.au/s?k=cold+cap%2C+cold+mitt%2C+cold+socks&crid=66QLP94BLA73&sprefix=cold+cap+cold+mitt+cold+socks+%2Caps%2C253&ref=nb_sb_noss
Cancer Council. Peripheral neuropathy. Accessed 30May25, from https://www.cancer.org.au/cancer-information/cancer-side-effects/peripheral-neuropathy
EviQ. (2023). Anti-cancer drug induced peripheral neuropathy. NSW Government. https://www.eviq.org.au/clinical-resources/side-effect-and-toxicity-management/neurological-and-sensory/1743-anti-cancer-drug-induced-peripheral-neuropath#management
Loprinzi, C. L., Lacchetti, C., Bleeker, J., Cavaletti, G., Chauhan, C., Hertz, D. L., Kelley, M. R., Lavino, A., Lustberg, M. B., Paice, J. A., Schneider, B. P., Smith, E. M. L., Smith, M. L., Smith, T. J., Wagner-Johnston, N., & Hershman, D. L. (2020). Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO guideline update. Journal of Clinical Oncology, 38(28), 3325—3350. https://ascopubs.org/doi/pdf/10.1200/JCO.20.01399
Mizrahi, D., Goldstein, D., Trinh, T., Li, T., Timmins, H. C., Harrison, M., Marx, G. M., Hovey, E. J., Lewis, C. R., Friedlander, M., & Park, S. B. (2022). Physical activity behaviours in cancer survivors treated neurotoxic chemotherapy. Asia-Pacific Journal of Clinical Oncology, 19(1), 243—249. https://onlinelibrary.wiley.com/doi/10.1111/ajco.13834
Hanai. A et al. Effects of cryotherapy on objective and subjective symptoms of paclitaxel-induced neuropathy: Prospective self-controlled trial. JNCI: Journal of the National Cancer Institute, Volume 110, Issue 2, February 2018, Pages 141–148, /doi.org/10.1093/jnci/djx178. Accessed January 2020.
Brooks. K and Kessler. T. Treatments for neuropathic pain. The Pharmaceutical Journal. December 2017. Accessed January 2020. Available here: pharmaceutical-journal.com/article/research/treatments-for-neuropathic-pain
& Macmillan (UK).
Please contact our Nurses on 07 5445 5794 or [email protected] if you have any questions.
All information provided by Bloomhill is mainly based on research from the Qld Cancer Council and best practice guidelines. Our model of care utilizes the Clinical Oncology Society of Australia (COSA) domains of wellness along with available clinical evidence. Always consult your care team regarding matters that affect your health. This is a guide intended for information only.
