Today we return to our ongoing series about the causes of neuropathy. We have now covered DPN, DAN, and other types of Diabetic Nephropathy, and this week turn our attention to neuropathy as a result of cancer related treatments. Chemotherapy-induced peripheral neuropathy (CIPN) is a unfortunately a common side effect of chemotherapy treatments involving many of the drugs used in chemotherapy. An estimated 30 to 40 percent of chemotherapy patients develop CIPN. It is also a major reason some patients stop chemotherapy treatment all together. This is my personal cause of neuropathy and I got it during my third course of cisplatin and etoposide. Though doctors and researchers are continually working to refine cancer treatments, therapies to treat the disease can still have side effects. While surgeries, other cancer treatments such as radiation, and even the cancer itself (tumor pressing on the peripheral nerve) can also cause induced nephropathy, chemotherapy is the largest cause.
What are the symptoms of CIPN?
CIPN will present effecting both sides of the body in the same way and is likely to begin in a patients toes, but then can move to feet, legs, hands, and arms. The below symptoms can range from mild to severe. Some of the more common symptoms are:
tingling, pins-and-needles, or bed of nails sensation
sharp, stabbing pain (mine is like a railroad spike being driven up my foot)
burning or shock-like sensations
loss of sensation or complete numbness
trouble with small motor skills such as writing, texting, and buttoning
gripping problems (dropping things)
clumsiness
weakness
Sufferers may also experience:
over sensitivity to touch
balance and coordination problems, which can lead to stumbling or falling when walking
differences in a patients sensitivity to temperature, making it harder to gauge heat and cold
reduced reflexes
swallowing difficulties
jaw pain
hearing loss
constipation
trouble urinating
I remember the (deer in headlights) moment when my diagnosis was in, I had the surgery to remove the tumor, and I was meeting with the oncologist to learn of my "treatment plan." I would be taking a triple cocktail of chemotherapy drugs 6 hours a day for a week and then three weeks off, for five rounds. I remember being given a pile of packets (basically small books) about each of these drugs: bleomycin; etoposide; and cisplatin, covering the potential side effects and so on and so on. When you are hit in the face with cancer however, you look less at the side effects and ask the big question of whether you will beat the cancer. I do remember there was some worries about kidney damage which other prescription drugs were given to mitigate. I am sure I read it in these packets, but I had no idea what what neuropathy was at this point, and really could not care.
Causes of CIPN
Some of the chemotherapy drugs associated with CIPN are:
nanoparticle albumin bound-paclitaxel (Abraxane)
bortezomib (Velcade)
cabazitaxel (Jevtana)
carboplatin (Paraplatin)
carfilzomib (Kyprolis)
cisplatin (Platinol)
docetaxel (Taxotere)
eribulin (Halaven)
etoposide (VP-16)
ixabepilone (Ixempra)
lenalidomide (Revlimid)
oxaliplatin (Eloxatin)
paclitaxel (Taxol)
pomalidomide (Pomalyst)
thalidomide (Thalomid)
vinblastine (Velban)
vincristine (Oncovin, Vincasar PFS)
vinorelbine (Navelbine)
Furthermore, while receiving chemotherapy, neuropathy can be cause or aggravated by other conditions such as: alcohol use disorder, autoimmune disorders, diabetes mellitus, HIV, infections that lead to nerve damage, poor peripheral blood circulation, shingles, spinal cord injury. and vitamin B deficiency
Duration of CIPN
Symptoms can appear as soon as chemotherapy begins. For me it did not appear the first round of these drugs that I had, but it appeared after the cancer had came back and I had another course of different chemotherapy drugs, another surgery, and I was going to just do a small course of these original chemotherapy drugs (to clear straggling cancer up). Oops!
Symptoms tend to get worse as the chemotherapy regimen progresses. It can be a temporary condition for some lasting only a few days or weeks. However, unfortunately for others it can last for months, years, or even become a life long condition.
Treatment for CIPN
Make sure to tell your oncologist as soon as possible that you are experiencing the symptoms and they will determine if the neuropathy is caused by chemotherapy and then monitor your treatment. They may treat the symptoms by:
steroids to reduce inflammation
topical numbing medicines
antiseizure medications, which can help relieve nerve pain
prescription-strength pain relievers such as narcotics (opioids)
antidepressants
electrical nerve stimulation
occupational and physical therapy
They may also depending on the severity of the neuropathy chose to lower the does of your chemotherapy drug, switch to another drug, delay until symptoms improve, or in worse cases stop the chemotherapy.
The Good News (Well Promising News Anyways)
Researches such as those at the University of Texas MD Anderson Cancer Center in Houston, TX and The Mayo Clinic in Rochester, MN are working to manage and lesson CIPN through developing new treatments for CIPN. Sarah Prinsloo, Ph.D., an assistant professor in the Department of Palliative, Rehabilitation, and Integrative Medicine at MD Anderson, and others are in pre-clinical studies and clinical trials, she and her colleagues are testing pharmacological and noninvasive neuromodulation treatments to control—and perhaps even reverse—CIPN.
“Many factors might contribute to CIPN, including patients’ inherent susceptibility, their genetic makeup, and the amount and duration of their chemotherapy,” said Salahadin Abdi, M.D., Ph.D., a professor in and chair of the Department of Pain Medicine at MD Anderson. CIPN is typically treated with antidepressants, anticonvulsants, and/or analgesics. Topical numbing agents such as lidocaine are sometimes used, and opioids may be employed in cases involving extreme pain. However, none of these options are especially effective, and all have adverse effects. “Overall, the current medications for treating CIPN are not satisfactory,” Dr. Abdi said. “Other options need to be developed.”
Given the limitations of currently available pharmaceutical interventions, more physicians and their patients are turning to nonpharmaceutical meansof addressing neuropathy. One area that has shown particular promise is neuromodulation.
“Anything the brain can learn to do—including processing pain—it can learn to do differently,” Dr. Prinsloo said. “Neuromodulation is training the brain to do something different than what it is currently doing using feedback, stimulation, or other nonpharmaceutical means.”
Neuromodulation-based interventions under investigation at MD Anderson include scrambler therapy, repetitive transcranial magnetic stimulation (rTMS), and neurofeedback. We will keep you updated on these treatments in future articles just subscribe.
So hang in there! For now you can join our online community to be able to ask others about their tips and tricks for living with this horrible condition. You can also check out our other articles that will give you guidance, and start with our website neuropathy.info.
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