Peripheral Neuropathy

Numbness or tingling in the hands and feet is called peripheral neuropathy and is caused by irritation or damage to the nerve endings in the hands and feet and the central nervous system (CNS).

Some chemotherapy drugs can cause peripheral neuropathy. If you have a numbness or a tingling, burning (or freezing) pain, or a prickling sensation, you should notify your doctor immediately.

Treatment for peripheral neuropathy that is caused by chemotherapy is to stop the therapy or change to a different drug that does not cause damage to the nerves. If immediate steps are not taken at the onset of symptoms, peripheral neuropathy can become a long-term problem. 

What causes peripheral neuropathy?

There are many possible causes of numbness and tingling. Some of the more common of these include:

• Diabetes
• AIDS
• Uremia (too much urea in the blood due to kidney problems)
• Severe malnutrition
• Trauma, such as broken or dislocated bones
• Cancer
• Certain medicines or toxic substances

The chemotherapy and other cancer drugs that may cause symptoms are listed in table 1.

Table 1. Cancer drugs that have been reported to cause peripheral neuropathy in more than 10% of patients

What are the symptoms of peripheral neuropathy?

In addition to numbness and tingling, other symptoms of peripheral neuropathy include weakness, pain in the arms, hands, legs and/or feet, and abnormal sensations such as burning, tickling, pricking or tingling, also known as paresthesia.

The areas of the body most commonly affected by peripheral neuropathy are the fingers and toes. Symptoms usually start at the end of the extremity and gradually move upward. Bowel function may also be compromised, causing or worsening constipation and eventually causing blockage of the intestines.

What can be done about peripheral neuropathy?

If you have symptoms of peripheral neuropathy, you should notify your doctor before your next treatment or at your next visit unless you have severe symptoms. Treatment for peripheral neuropathy that is caused by chemotherapy is to stop the treatment or change to a different drug that does not cause damage to the nerves. If immediate steps are not taken at the onset of symptoms, peripheral neuropathy can become a long-term problem. 

Recovery from peripheral neuropathy is usually slow, but steps can be taken to encourage regeneration of the damaged nerves. Some approaches include acupuncture, massage, physical therapy, transcutaneous nerve stimulation, and medication.

Acupuncture - A technique originating thousands of years ago in the Chinese culture, acupuncture uses thin needles inserted into the body at certain points. Each point controls the energy, called "Chi" in Chinese medicine, in different parts of the body. These points also appear to control sensation, such as pain or numbness. Acupuncture has been shown to relieve pain associated with peripheral neuropathy.

Massage - By increasing blood flow, massage may provide pain relief associated with peripheral neuropathy.

Physical therapy - Through range of motion and stretching exercises, physical therapy may strengthen muscles that are weak and improve other symptoms of peripheral neuropathy.

Transcutaneous nerve stimulation (TNS) - Through the use of a special device that transmits electrical impulses through electrodes attached to your skin, TENS has been shown to provide pain relief and may promote nerve regeneration.

Medications - Drugs, such as Neurontin® (gabapentin) and Lyrica® (pregabalin), can sometimes relieve the symptoms of peripheral neuropathy.