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Management of peripheral neuropathy |
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Peripheral neuropathy can be classified according to severity of symptoms: Mild – symptoms do not affect daily activities. Moderate – symptoms are painful, difficulty in performing some daily activities. Severe – pain is incapacitating, most daily activities affected. Mild Symptoms For mild symptoms, nonpharmacologic intervention may be helpful. Some patients with mild peripheral neuropathy have found that applying ice or soaking affected hands or a foot in cold water (or ice water) twice a day helps to reduce the symptoms. Other patients have found that wearing shoes with greater support helps to reduce symptoms associated with peripheral neuropathy in the feet. Certainly these are temporary measures and may not completely eliminate symptoms. Moderate Symptoms Pharmacologic therapy may be considered for patients with symptoms of moderate severity. Some patients may find relief with an over-the –counter pain reliever such as paracetamol. Vitamin B6 also has been reported to reduce symptoms, with varying degrees of success. If these interventions fail amitriptyline may be initiated with a non-opioids pain reliever. Symptoms need to be evaluated and the dose of amitriptyline modified if necessary. More powerful pain relievers also may be prescribed if symptoms cannot be managed, including opioid pain relievers. Carbamazepine, which has been utilised to treat neuropathic pain, may not be appropriate for patients in chemotherapy because of the haematologic toxicities with which it is associated. Severe Symptoms In the case of severe pain, dose reduction or discontinuation of medication would be appropriate. It is recommended that in the case of severe peripheral neuropathy, the dose of chemotherapy be reduced subsequent courses.
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