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Coping with Cancer > Side Effects > > Peripheral Neuropathy (Nerve Damage)

Managing Symptoms: Peripheral Neuropathy (Nerve Damage)

The Abramson Cancer Center of the University of Pennsylvania
Last Modified: May 14, 2009

What Is Peripheral Neuropathy?
Neuropathy is irritation or damage to nerves. Nerves are long, wire-like fibers in our body that transmit information from one area of our body to another. There are three types of peripheral nerves:

• Motor nerves relay information to and from your muscles, telling them when to contract and how forcefully.
• Sensory nerves allow you to feel temperature, pressure, and pain. They also help determine where your arm/leg is in space.
• Autonomic nerves help regulate your breathing, heart rate and blood pressure.

Peripheral neuropathy is a condition in which a nerve or group of nerves have difficulty "communicating" with each other. When just the ends of nerves (the "periphery") are affected, this is called peripheral neuropathy. Damaged sensory nerves do not accurately "sense" heat, cold, pressure, pain and body position. Damaged motor nerves do not accurately tell muscles to contract and move.

What Causes Peripheral Neuropathy and How Long Will It Last?
Certain chemotherapy drugs can damage peripheral nerves, especially with higher doses or after multiple doses. The most common chemotherapy drugs that may cause peripheral neuropathy are: Vincristine, Vinblastine, Taxol, Taxotere and Cisplatin.

Occasionally during radiation therapy, injuries occur that could put pressure on nerves. Injuries to nerves could also occur during surgery. And, finally, cancerous tumors can put pressure on nerves or release substances that affect nerves.

For most people, symptoms due to treatment may improve or resolve within 6-12 months. Some people do experience these symptoms for a longer period of time.

What are the Common Symptoms of Peripheral Neuropathy?
When neuropathy occurs, one or several of your peripheral nerves have difficulty sensing information. This may lead to such symptoms as weakness, pain, imbalance, numbness or dizziness. These symptoms may limit your ability to perform daily activities such as walking or dressing.

Call your Doctor or Nurse if you have any of the following symptoms of nerve damage:

Motor Symptoms

• Legs or arms feel heavy
• Tripping
• Difficulty lifting up foot or toes
• Difficulty picking up or holding objects, or manipulating them in your hand
• Difficulty using buttons
• Shaky handwriting

• Arm or leg feels like "pins and needles" or are numb
• Cold feeling in arm or leg
• Burning or "electrical" feeling
• Difficulty hearing
• Ringing in ears
• Vision changes

• Dizziness upon standing
• Feeling flush
• Heart racing
• Constipation

How Is Peripheral Neuropathy Diagnosed?
Peripheral neuropathy is diagnosed by taking a thorough medical history. Your doctor may also recommend a test called electromyography, or EMG, to help make this diagnosis. This test will show how well information travels along a nerve and which type of nerve is most affected.

What Can I Do?

• Contact your doctor or nurse immediately if you have any of the above symptoms. Treating nerve damage early may prevent the symptoms from getting worse.
• If you experience pain, your physician may recommend medication, such as Elavil, Pamelor or Neurotin. These medications may have side effects and should be closely monitored by a physician.
• Physical therapy can enhance your balance, strength and safety. Braces may be needed to help with extreme muscle weakness and instability.
• Occupational therapy can enhance fine motor coordination, such as writing, and therapists can help adapt your home to account for the changes in your situation.
• Since peripheral neuropathy may affect your mobility and ability to sense temperatures, it is important to take some simple precautions to ensure your safety. Ideas include:
• Make sure your house is well lit.
• Keep a night light on in your room and along the path to the bathroom.
• Cover all steps with a non-skid surface.
• Clear stairs and hall of objects.
• Mark the edge of the step with a bright color to help determine where the step ends.
• Use handrails.
• Tape down the edges of all throw rugs to avoid tripping.
• Bathtub/shower should have a non-skid surface.
• Test the temperature of the water with an area of your body that is not effected by the neuropathy.
• Always check your feet and shoes at the beginning and end of each day. You may not feel small pebbles that can irritate your foot and cause an open sore.

Talk to your nurse or physician about these symptoms. You may benefit from a referral to the Cancer Rehabilitation Program at the The Abramson Cancer Center of the University of Pennsylvania for specialized treatment of your peripheral neuropathy symptoms.