What is Chemotherapy-Induced Peripheral Neuropathy?

Each case of chemotherapy-induced neuropathy is unique and affects different nerves. Symptoms can affect different parts of the body but generally include:

• Numbness, tingling, burning, pain, or pins-and-needles sensation
• Decreased sensation
• Muscle weakness
• Sensitivity to touch and temperature
• Difficulty using fine motor skills
• Clumsiness 

Neuropathy symptoms may manifest as soon as hours after a chemotherapy treatment but often peak 3 to 5 months after the final dose. Pain may intensify with each cycle of chemotherapy. 

Chemotherapy affects the whole body, not just the disease being treated. These powerful, toxic drugs not only harm cancer cells but the peripheral nervous system and other functions as well. It is estimated that 30 to 40 percent of people who receive chemotherapy develop CIPN.

Some chemotherapy drugs, including platinum drugs, taxanes, vinca alkaloids, and myeloma treatments, are more likely to cause neuropathy. Risk increases with higher doses, multiple cycles, and combination treatments. 

Chemotherapy patients with diabetes, vitamin deficiencies, or prior neuropathy are at a higher risk of developing CIPN. If left untreated, CIPN can lead to other complications, including blood pressure changes, heart rate changes, falls, dyspnea, paralysis, and organ failure.

A medical professional will evaluate your symptoms, severity, and medical history to diagnose CIPN and determine the best course of treatment. The diagnosis may involve:

• Physical exam: the doctor will look for weakness in specific muscles and ask you about changes in sensation throughout your body
• Nerve conduction: evaluates the speed at which your nerves respond to electrical signals
• Electromyography (EMG): measures muscle and nerve response to determine whether the muscle responds appropriately to stimulation
• MRI and CT scans: check for tumors, cysts, and other masses that could be compressing the affected nerves

Some cases of CIPN disappear or become milder several months to a year after the chemotherapy treatment is complete. Symptoms may also disappear if you reduce the dosage or stop taking the drug causing the neuropathy. Many patients make the decision with their care team to change, delay, or end their chemotherapy treatment for this reason.

However, nerve damage from CIPN can sometimes be permanent. Pain can be managed with over-the-counter medications, patches, and creams. You may also get relief with steroid injections to reduce inflammation and prescription medications. Physical therapy can be integrated into any care plan to gradually improve nerve function.

In advanced cases, such as Debbie’s chemotherapy-induced neuropathy, you may need surgery to reverse the nerve damage and return comfortably to everyday activities. Surgical breakthroughs at The Institute for Advanced Reconstruction allow for some cases of nerve damage to be reversed. Available treatments include:

Nerve decompression

Nerve decompression surgery can remove the underlying cause of neuropathy by relieving the pressure on the affected nerve. This innovative, minimally invasive procedure involves just three small incisions to allow doctors to release the damaged nerve from whatever is compressing it.

The procedure lasts about an hour and a half and helps most patients achieve significant pain relief and regain some sensation and mobility immediately. They typically return to everyday activities in two to three weeks and can achieve further improvements and long-lasting results with physical therapy.

Nerve repair

Nerve repair surgery is an option for some patients whose nerves are too damaged to heal from decompression alone. It involves removing scar tissue from the nerve endings, then reconnecting the nerve with a small suture to restore function.

The procedure can take over two hours and recovery times may vary depending on the extent of the damage. Sometimes, the nerve function is restored quickly, other times, it can take months for the injured muscle to fully regrow.

Nerve transplant

Severe nerve damage may result in a large section of the nerve being crushed or missing. A nerve transplant, sometimes called a nerve graft, involves bridging the gap with nerve tissue taken from somewhere else in the body (autograft) or from a cadaver (allograft). Similar to splicing a wire, the nerve will regenerate through the transplant to restore movement and sensation.

A nerve transplant can take several hours to complete. Recovery can take several weeks or months, as it takes time for the nerve fibers to regrow. 

The Institute for Advanced Reconstruction participates in a wide range of insurance plans, including those listed below. However, each physician has their own accepted insurance and hospital affiliations. Before scheduling an appointment, please contact your insurance carrier to confirm that your provider is in-network.

• Horizon Blue Cross Blue Shield of New Jersey
• Medicare
• Railroad Medicare
• Aetna
• Cigna
• United Healthcare
• Oxford (Freedom, Liberty)
• MagnaCare

Visit our resource page for patient forms, information specific to chemotherapy-induced neuropathy, and more.