How To Identify and Manage Chemotherapy Induced Peripheral Neuropathy

Chemotherapy induced peripheral neuropathy (CPIN) is a complex condition experienced by many individuals undergoing chemotherapy. In fact it affects up to 68% of patients receiving chemotherapy, with symptoms persisting for at least 6 months in about 30% of individuals. 

The condition occurs when certain chemotherapy drugs damage your peripheral nerves, which are the nerves responsible for transmitting signals between your body and your brain. When these nerves are damaged, you may develop a variety of sensory and motor symptoms that can significantly impact your quality of life and daily function. 

Signs and Symptoms of CIPN: 

The onset of these symptoms can be sudden or slowly progress over the course of your chemotherapy appointments. However, regardless of the onset, recognizing the symptoms of CIPN early is important for effective management. 

Here are the common signs to watch for:

  • Tingling and Numbness: The most common symptom of CIPN is tingling in both hands and/or feet. This can often lead to numbness, making it difficult for you to feel sensations normally.
  • Pain: Pain in the hands and/or feet is another common symptom of CIPN. This pain is often described as shooting, burning, or stabbing. The pain may be constant or come and go, and can vary in intensity.
  • Muscle Weakness: As CIPN progresses, it can cause significant muscle weakness in your hands and/or feet, making everyday tasks like picking up objects, buttoning a shirt, frequent tripping, or maintaining your balance more difficult.
  • Sensitivity Changes: You might also experience increased sensitivity to touch, temperature, or pressure. Some people also find it hard to distinguish between hot and cold, increasing their risk of burns or frostbite.
  • Coordination and Balance Issues: Due to the sensory and motor changes described above, balance problems are also common, which can increase your  risk of falls and injuries.

    • If you notice any of these symptoms, don’t hesitate to bring them up to your healthcare team so that they can provide you with guidance and education.

    Managing CIPN

    One of the biggest misconceptions about CIPN is that nothing can be done to manage or treat the condition. However, this is not true. There are several effective ways to manage CIPN and improve your symptoms, daily function, and quality of life. 

    1. Adjusting Chemotherapy Regimen: In some cases, adjusting the dose or schedule of your  chemotherapy may be necessary to manage symptoms. This should be done under the guidance of your healthcare team.
    2. Physical and Occupational Therapy: These therapies can help improve your balance, strength, fine motor skills, and overall function. They are also particularly beneficial for managing numbness, tingling, and pain associated with CIPN.
    3. Medications: Pain medications such as gabapentinoids, anti-seizure drugs, and antidepressants can help manage the symptoms of CIPN. It's important to work with your healthcare team to find the right combination of medications.
    4. Diet and Supplements: A well-balanced diet and certain vitamins, such as B-complex, folic acid, and fish oils, may help manage symptoms. However, it's crucial to consult with a healthcare provider before starting any supplements, as some may interfere with cancer treatment.
    5. Complementary Therapies: Techniques such as acupuncture, relaxation exercises, and guided imagery can help manage the side effects of CIPN.
    6. Lifestyle Modifications: Avoiding alcohol and smoking can help prevent worsening of neuropathy symptoms. 

    Role of Physical/Occupational Therapy in Managing CIPN

    A physical or occupational therapist specialized in Cancer Rehabilitation plays a vital role in managing the symptoms of CIPN and improving the quality of life and function of those affected by the condition. 

    Here are some ways in which physical therapy can help:

    1. Pain Management: With the use of a variety of hands-on techniques and pain modalities, the therapist can help you to successfully reduce your pain and discomfort. 
    2. Sensory Re-Education: The therapist will also employ specialized techniques to help retrain your sensory nerves and pathways. This method involves manual exploration of touch, pressure, and temperature in your affected area to normalize your sensation to these stimuli. 
    3. Desensitization Techniques: This involves gradually exposing your affected area to different textures and sensations to help reduce your hypersensitivity and pain. It is a behavioral therapy technique that can help patients become more accustomed to sensations that previously caused discomfort.
    4. Balance and Coordination Training: Since sensory changes can affect your balance, the therapist will also provide you with exercises to improve your balance and coordination. This will help to reduce your risk of falls.
    5. Targeted Exercises: Based on your needs and abilities, the therapist will design a personalized exercise program to improve your strength, flexibility, and overall physical function. They will also provide you with exercises for sensorimotor training, to reduce your sensory symptoms. These specialized exercise programs are designed to improve both your sensory and motor functions, helping you regain normal sensation and daily functioning. 
    6. Bracing and Gait Aids: The therapist may also provide you with a custom brace or gait aid to enhance your mobility, reduce your pain, and decrease your risk of falls.

    In conclusion, chemotherapy-induced peripheral neuropathy (CIPN) presents a range of challenging symptoms, including tingling, numbness, pain, and muscle weakness, which can significantly impact your daily life. However, there are effective management strategies available, including medications, physical and occupational therapy, exercise, and lifestyle modifications. 

    Physical and occupational therapists specialized in Cancer Rehabilitation play a vital role in the treatment of CIPN, by providing personalized interventions such as pain modalities, sensory re-education, desensitization techniques, and the use of targeted exercises. Patients can thus find relief from their symptoms and improve their quality of life. 

    About the Author:

    Amanda Grilli, PT, CLT is a physical therapist, certified lymphedema therapist, and cancer coach specializing in breast cancer recovery and lymphedema treatment. She uses a whole-body treatment approach, combining hands-on therapy and individualized exercises, to help her patients overcome their cancer-related side effects and maximize their well-being during and after breast cancer treatments. 

    Amanda is also the founder and executive director of Well Beyond Breast Cancer, a 501(c)3 non-profit organization dedicated to improving the quality of life of the breast cancer community through increased accessibility to breast cancer rehabilitation and lymphedema therapy. Their Financial Assistance Program provides those in need of financial support with no-cost appointments of breast cancer rehabilitation with specialized physical/occupational therapists across the US. To learn more about Well Beyond Breast Cancer, feel free to visit their website. 

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