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What is chemotherapy-induced peripheral
neuropathy or CIPN?
Chemotherapy-induced (chemo-induced) peripheral neuropathy may
be called CIPN for short. It is a set of symptoms or problems caused by
damage to peripheral nerves. Peripheral nerves are nerves that control
the sensations and movements of our arms and legs. Chemo-induced
peripheral neuropathy is caused by the chemotherapy drugs used in
cancer treatment.
What are the symptoms of CIPN?
The symptoms or signs of CIPN depend mostly on which nerves
are involved. The most common symptoms are:
- pain
- burning
- tingling (or a "pins and needles" feeling)
- muscle shrinkage
- weakness
- balance problems
- trouble with tripping and stumbling while walking
- loss of feeling (numbness)
- decreased or no reflexes
- increased sensitivity to temperature (usually cold) or
pressure, so that things hurt more than usual
- constipation
- trouble passing urine
- blood pressure changes
- trouble swallowing
CIPN often affects both sides of the body the same way; for
example, the toes of both feet. It can cause severe pain and can affect
your ability to do everyday things like walk, write, button your shirt,
or pick up a coin. If it gets very bad it can cause very serious
problems like changes in your heart rate, trouble breathing, paralysis,
or organ failure.
vTalk to your doctor or nurse right away about any signs of
CIPN that you may have. They will want to watch the signs to see if
they get worse.
What else can cause these symptoms?
Peripheral neuropathy (PN) can also have other causes, such
as:
- other cancer treatments, such as surgery or radiation
- tumors pressing on nerves
- infections that affect the nerves
- diabetes
- shingles
- low vitamin B levels
- some autoimmune disorders
It's very important to understand the cause of PN so that the
right treatment can be given. The focus here will be on peripheral
neuropathy that is a side effect of chemotherapy or chemo -- CIPN.
How is chemo linked to CIPN?
Because chemo goes throughout the body, it can damage many
different nerves, leading to neuropathy. CIPN often affects both sides
of the body the same. In most cases, symptoms of CIPN start in the feet
and over time start in the hands, too. You may hear this called
"stocking/glove distribution."
CIPN can begin any time after treatment is given. Sometimes it
gets worse as treatments go on.
What drugs are most likely to cause CIPN?
Certain chemo drugs are more often linked to CIPN. These
include:
- platinum drugs like cisplatin, carboplatin, and oxaliplatin
- taxanes including paclitaxel (Taxol®)
and docetaxel
(Taxotere®)
- epothilones such as ixabepilone (Ixempra®)
- plant alkaloids such as vinblastine, vincristine,
vinorelbine, and etoposide
- thalidomide (Thalomid®) and
lenalidomide
(Revlimid®)
- bortezomib (Velcade®)
CIPN can be short-term or can become a long-term problem
depending on things like:
- your age
- having other medical conditions that cause
neuropathy (like diabetes or HIV infection)
- whether or not you have a history or family history
of neuropathy
- the drug or combination of chemo drugs used
- the drug dose
- the total dose of chemo given over time
What may happen if I get CIPN?
Your health care team needs to know if your chemo is causing
signs of CIPN. They will ask you about your symptoms and watch you to
see if the CIPN is getting worse. Your doctor or nurse 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.
Can CIPN be prevented?
Many treatments have been used to try to prevent CIPN. Below
is a list of some of the treatments that have been tried. So far, study
results have been mixed for all of these treatments, and more research
is needed.
Vitamin E:
Some studies have shown that this antioxidant may
protect nerves from the damage caused by cisplatin and paclitaxel.
Calcium and
magnesium: One small study showed patients who
were given calcium and magnesium infusions before and after oxaliplatin
reported less CIPN.
Anti-convulsants:
The anti-seizure drug carbamazepine is being
studied to see if it can help prevent or treat CIPN.
Other
substances: Some substances made by our bodies are also
being looked at to see if they can help protect nerve cells from being
damaged by chemo. This includes things like amino acids and proteins.
Many of these are being studied as supplements given before and after
chemo.
So far, there is no sure way to prevent CIPN. But this is a
major problem for some people, and doctors are looking for treatments
that work.
What may be done to help lower the risk of
CIPN?
There are 2 things that may be done to lower the risk of CIPN.
Some doctors are trying smaller doses of chemo spread out over more
time. For example,
- Instead of giving one large dose once a week,
smaller doses are given 2 or 3 times a week.
- The same dose is given over 6 hours instead of over
1 hour.
- The drug can be given as a non-stop, very slow
infusion over a few days.
Doctors may also try a stop-and-go treatment plan. For this,
the chemo is given until a certain dose is reached, or until CIPN
reaches a certain level. Then the treatment is stopped until the CIPN
problems get better or until the cancer seems to be growing again. When
this happens the chemo is restarted, often at a lower dose than before.
This stop-and-go treatment is now being studied to see how it affects
CIPN and treatment outcomes.
Can CIPN be treated?
Sometimes the symptoms of CIPN are short-term. They go away
over time after treatment is done. In other cases, it can take up to 2
years for the symptoms to totally go away, and sometimes they last much
longer and need long-term treatment. Severe CIPN may never go away.
Treatment is mostly done to relieve the pain that can come
with CIPN. Some of the drugs used include the following:
- steroids,
only 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)
- anti-depressant
medicines, often in smaller doses
than are used to treat depression
- anti-convulsant
medicines
- opioids or
narcotics for severe pain
Other treatments that can be tried to ease neuropathic pain
(pain that comes from nerves) include:
- occupational therapy
- physical therapy
- relaxation therapy
- acupuncture
- biofeedback
What can I do to deal with CIPN?
There are some things you can do to better deal with the
symptoms of neuropathy, such as
- Use your pain medicines if you have them. Most pain
medicines work best if they are taken before the pain gets bad.
- Avoid the things that seem to make your CIPN worse,
such as hot or cold temperatures, or snug clothes or shoes.
- Don't drink alcohol. It can cause nerve damage on
its own, and may make CIPN worse.
- If you have diabetes, control your blood sugar.
High blood sugar levels can damage nerves.
- If the neuropathy is in your feet, sit down as much
as possible, even while brushing your teeth or cooking.
- Take care of your feet. Look at them often to see
if you have any open sores and talk to your doctor about shoes or
special inserts that may help you.
- Talk to your doctor or nurse about the problems you
are having in daily life. They might be able to suggest ways to make
you feel better or function better.
What questions should I ask?
Here are some questions you may want to ask your health care
team:
- Is the chemo I am getting likely to cause CIPN?
- Am I at high risk for CIPN?
- How will you test me to see if I have CIPN?
- Have you treated CIPN in other patients? How? Did
it work?
- Is it likely that my CIPN will get better or go
away after treatment is over?
- If my CIPN gets bad and is very painful, will it
change my treatment plan?
Talk to your health care team
It is important to work closely with your doctor or nurse to
manage peripheral neuropathy caused by your chemotherapy. Talk to your
doctor about any changes in how you feel or any pain you have and how
it affects the things you do every day. You can get learn more about
pain and how to talk about it in Pain Control: A Guide for Those
with
Cancer and Their Loved Ones.
Additional
resources
More
information from your American Cancer
Society
The following information may also be helpful to you. These
materials may be ordered from our toll-free number, 1-800-ACS-2345
(1-800-227-2345).
- After Diagnosis: A Guide for Patients and Families (also
available in Spanish)
National organizations and Web sites*
In addition to the American Cancer Society, other sources of
patient information and support include the following:
National Cancer Institute
Toll-free number: 1-800-422-6237 (1-800-4-CANCER)
Web site: www.cancer.gov
The Neuropathy Association
Telephone: 1-212-692-0662
Web site: www.neuropathy.org
*Inclusion on
this list does not imply endorsement by the
American Cancer Society.
No matter who you are, we can help. Contact us anytime, day or
night, for cancer-related information and support. Call us at
1-800-ACS-2345 (1-800-227-2345)
or visit www.cancer.org.
References
Coyle N, Silver J, Meuche G, Messner C. Understanding
Peripheral Neuropathy. CancerCare booklet edited and
produced by
Elsevier Oncology. 2008.
Gamelin L, et al. Prevention of oxaliplatin-related
neurotoxicity by calcium and magnesium infusions: A retrospective study
of 161 patients receiving oxaliplatin combined with 5-fluorouracil and
leucovorin for advanced colorectal cancer. Clin Cancer Res.
2004; 10:
4055-4061.
Tournigand C. OPTIMOX1: A randomized study of FOLFOX4 or
FOLFOX7 in a stop-and-go fashion in advanced colorectal cancer--A
GERCOR study. J Clin
Oncol. 2006; 24: 394-400.
Visovsky C, Collins M, Abbott L, Aschenbrenner J, Hart C.
Putting evidence into practice: Evidence-based interventions for
chemotherapy-induced peripheral neuropathy. Clin J Oncol Nurs.
2007;
11: 901-913.
Wickham R. Chemotherapy-induced peripheral neuropathy: A
review and implications for oncology nursing practice. Clin J Oncol
Nurs. 2007; 11: 361-376.
Last Medical Review: 08/08/2008
Last Revised: 08/08/2008
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