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How to Deal with Neuropathy

Manage chemotherapy-induced peripheral neuropathy (CIPN) to improve your quality of life

“Due to its high prevalence among cancer patients, CIPN constitutes a major problem for both cancer patients and survivors as well as for their health care providers, especially because, at the moment, there is no single effective method of preventing CIPN; moreover, the possibilities of treating this syndrome are very limited.” doi: 10.3390/ijms20061451 .

Neuropathy is caused by nerve damage, and the resolution of symptoms depends largely on how well your nerves recover. Furthermore, recovery depends on the length of your treatment, extent of the damage and the chemo dose intensity. To date, there have been no proven interventions to prevent CIPN, and options to treat CIPN are limited. During treatment, your cancer care team will ask you about your symptoms and monitor to see if the CIPN is getting worse. Depending on the severity of your symptoms and to prevent long-term damage, they may need to delay your treatment, use smaller doses of the chemo drugs, or stop treatment with the drug that is causing the CIPN until your symptoms get better.

Several grading systems are used to classify the severity of CIPN. They measure sensory and motor abnormalities on a grading scale of 0 (absent) to 4 (severe) based on findings from physical examination and patient reported symptoms. Depending on the severity of symptoms, your cancer care team may suggest medications, therapies and lifestyle changes. Together these different modalities can help with the symptoms of peripheral neuropathy.

“The approach to CIPN may therefore require a more “bespoke” assessment process that is designed to identify the particular characteristics of CIPN, as early as possible, to allow appropriate management (including potential alteration to the chemotherapy regimen). This has been recognised with the development of a number of screening tools specific for CIPN.”

Since there is no absolute way to cure CIPN, treatment is mostly given to relieve the pain that can come with neuropathy. Some of the medications used include:

  • Steroids for a short time until a long-term treatment plan is in place.

  • Patches or creams of numbing medicine that can be put right on the painful area (for example, lidocaine patches or capsaicin cream).

  • Antidepressants, such as Duloxetine but in smaller doses than are used to treat depression.

  • Anti-seizure medicines, which are used to help many types of nerve pain.

  • Opioids or narcotics, for severe pain

  • New trials using various compounds including Tetrodotoxin

Some of the non-medical options include:

  • Electrical Nerve Stimulation

  • Occupational Therapy

  • Physical Therapy

  • Relaxation Therapy

  • Guided Imagery

  • Distraction

  • Acupuncture

  • Biofeedback

Although there is anecdotal suggestion for use of certain vitamins and over the counter nutraceuticals such as acetyl-l-carnitine, alpha-lipoic acid, L-carnosine, vitamin B, vitamin E, calcium and magnesium supplements, till date, no reproducible trials have shown any statistically significant improvement in neuropathy with the use of any of these supplements. There are newer clinical trials studying the efficacy of certain compounds including calmangafodipir that have not been completed but show promising results. It is absolutely important that you do not start any of these supplements unless approved by your cancer care team.

A small study suggests that wearing frozen gloves and socks for 90 minutes during Taxol chemotherapy can help control neuropathy symptoms. The application of cooling protects against side effects of chemotherapy by reducing drug distribution at the cooled area through vasoconstriction, thus decreasing cellular uptake, and by decreasing biochemical activity in target tissues.

“Studies and systematic reviews of non-pharmacological interventions such as exercise and behavioral interventions suggest these treatment approaches may have potential beneficial effects on reducing CIPN symptoms and may be appealing because patients do not have to take another drug to treat another symptom.

While exercise cannot make peripheral neuropathy go away, studies show it can help minimize pain and improve strength and balance. Once you receive your doctor’s permission to exercise, meeting with a certified trainer or physical therapist can help determine the right combination of exercises for your symptoms and ensure that you are doing the exercises correctly. Because neuropathy affects your balance, it is important to exercise in a stable environment where you are less likely to fall down or drop something. Weightlifting machines rather than free weights are recommended so that you’re less likely to drop them and injure yourself. For a cardiovascular workout, try a stationary bike or swimming rather than a treadmill or elliptical machine. For leg and/or foot neuropathy, calf stretches, ankle circles, gentle walking, leg lifts, and balancing exercises can help.

For neuropathy in the hands, exercises such as therapy ball exercises, finger taps (tap each finger to the thumb, one at a time) or finger rolls (bend fingers, one at a time, into a fist) can help. Physical therapy is one of the most effective treatments for neuropathy as it helps with improvement in balance and strength. Occupational therapy can also be beneficial in improving fine motor skills like buttoning shirts, tying shoelaces or opening door handles, all of which can be affected by neuropathy.

It is important for patients to advocate for themselves by asking their cancer care team for a referral to a physical and/or occupational therapist.

There are several safety tips that you can follow at home and at work to protect your hands and feet and lessen the impact of neuropathy if you are suffering from it. Here is a handy checklist of suggestions:

  • Use gloves to protect your hands when doing yard work or household repairs.

  • Be extra cautious with sharp objects.

  • Use well-padded potholders when cooking.

  • 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.

  • Inspect your fingers and feet regularly for cuts and scrapes.

  • Check the weather and wear gloves and warm socks in cold weather.

  • Wear shoes with a rubber sole both inside and outside.

  • Always use cold water first and gradually move to warmer water- you can also check the water temperature with another part of your body.

  • If you cannot feel the gas pedal or brake, do not drive.

  • Avoid walking on uneven surfaces.

  • Keep floors clear of throw rugs, cords and other obstacles.

  • Consider handrails in stairways or grab bars in bathtub or toilet. Put rubber mats in the tub or shower so you do not slip.

  • If you need one, use a cane, walker or wheelchair.

  • Set the water heater in your home between 105-110 degrees.

  • Keep dark areas well lit and use a night light as needed.

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Reason to Hope

There is new research from Brigham and Women’s Hospital that indicates a Western-style diet that is rich in red and processed meat, sugar and refined grains/carbohydrates is tied to higher risk of colorectal cancer through the intestinal microbiota.  Gastroenterology, 2022;DOI:10.1053/j.gastro.2022.06.054 

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