Management of peripheral neuropathy

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The chemotherapy agents usually associated with "pins & needles" are vincristine, taxol, cisplatin and oxaloplatin. Not all patients receiving these drugs will experience symptoms of peripheral neuropathy, and a small number (5% ovarian and breast cancer patients, 6% NSCLC patients) will experience severe symptoms. Peripheral neuropathy is most often felt in hands and feet ("glove and stocking" distribution), and may be described as numbness, tingling or burning.

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.

 

Definition

Management Options

Mild

Symptoms do not affect daily activities

Nonpharmacologic treatment:

- Ice bath

- Support shoes

Moderate

Symptoms are painful; difficulty in performing some daily activities

Pharmacologic treatment:

  • Vitamin B6
  • Non opioid analgesics
  • Paracetamol
  • Opioid analgesics
  • Amitriptyline

Severe

Pain is incapacitating; most daily activities affected

Consider dose reduction or discontinuation; this may be temporary, depending on resolution of symptoms and/or tumour response to chemo

 

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.


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