JAMA ONCOLOGY PATIENT PAGE -Induced Peripheral Neuropathy

Peripheral neuropathy refers to symptoms arising from damage to peripheral nerves. These nerves carry sensation, control movements of the arms and legs, and control the bladder and bowel. Chemotherapy and other drugs used to treat can cause peripheral neuropathy. This is termed chemotherapy-induced peripheral neuropathy (or CIPN).

What Increases the Risk of Developing CIPN? Certain chemotherapy drugs are more likely to cause neuropathy. Chemotherapy-Induced These include: platinum drugs, such as oxaliplatin; taxanes, such as Peripheral Neuropathy (CIPN) docetaxel; vinca alkaloids, such as vincristine; and myeloma treat- Chemotherapy and other cancer treatments ments, such as bortezomib. can cause damage to the nerves away from the brain and spinal cord. Other chemotherapy drugs can also cause neuropathy.The risk of developing CIPN is higher with higher doses, multiple courses, and Symptoms of CIPN include combination chemotherapy.Patients are more likely to develop CIPN Tingling or pins-and-needles sensation if they are older or have diabetes, vitamin deficiencies, or preexist- Pain, burning, or numbness ing peripheral neuropathy. Sensitivity to hot or cold Difficulty with fine motor skills such as writing, buttoning and unbuttoning, How Can I Reduce My Risk of Developing CIPN? and picking up small objects No medication or supplement has been shown to definitively pre- vent CIPN. Regular exercise, reducing use, and treating Symptoms are usually symmetrical preexisting medical conditions (vitamin B12 deficiency) may re- and start at the fingers and toes, duce the risk of CIPN. progressing toward the body

What Are the Symptoms and Complications of CIPN? Depending on the nerves affected, symptoms include: • Tingling (“pins and needles”) kitchen to avoid burns. Your oncologist may choose to discontinue • Pain, which may be severe and constant, may come and go, or may or reduce the dose of a chemotherapy drug. Your oncologist may rec- feel like burning ommend over-the-counter pain medications, lidocaine patches, • Decreased sensation (“legs feel like jelly”) menthol creams, or a medication called duloxetine. Physical , • Increased sensitivity to touch, temperature, pressure, pain occupational therapy, and rehabilitation may be helpful to regain • Muscle weakness function. Studies are researching how novel (biofeed- Symptoms can appear hours to days after chemotherapy and back or scrambler therapy) can help. Improvements in function may may reduce in intensity with time. Commonly, symptoms occur be gradual. In some cases, nerve damage may be permanent. weeks to months after chemotherapy. They can get worse with ad- ditional cycles of chemotherapy.

What Should I Do If I Develop Symptoms? FOR MORE INFORMATION You should notify your care team. Symptoms are likely to worsen if https://www.cancer.org/treatment/treatments-and-side-effects/ not addressed. Your oncologist can diagnose CIPN based on symp- physical-side-effects/peripheral-neuropathy.html toms and by examining you. Specialized testing is rarely needed.

I Have CIPN—What Now? One should avoid injury by paying attention to home safety, such as by using handrails on stairs to prevent falls and potholders in the

Authors: Timothy J Brown, MD; Ramy Sedhom, MD; Arjun Gupta, MD The JAMA Oncology Patient Page is a public service of JAMA Oncology.The Published Online: February 28, 2019. doi:10.1001/jamaoncol.2018.6771 information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for . For specific information Conflict of Interest Disclosures: None reported. concerning your personal medical condition, JAMA Oncology suggests that you Section Editor: Howard (Jack) West, MD. consult your . This page may be photocopied noncommercially by and other professionals to share with patients. To purchase bulk reprints, call (312) 464-0776.

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