Peripheral Neuropathy
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Chemotherapy Side Effects
Neuropathy

Neuropathy (or peripheral neuropathy) is a collection of disorders that occurs when nerves of the peripheral nervous system (the part of the nervous system outside the brain and spinal cord) are damaged. The condition is generally referred to as peripheral neuropathy, and it is most commonly due to damage to nerve axons. Neuropathy usually causes pain and numbness in the hands and feet. It can result from chemotherapy drugs, traumatic injuries, infections, metabolic disorders and exposure to toxins. One of the most common causes of neuropathy is diabetes.

The body's nervous system is divided into two major systems; the central nervous system and the peripheral nervous system. The peripheral nervous system is also divided into two major parts, the somatic nervous system and the autonomic nervous system. The somatic nervous system consists of peripheral nerve fibers that send sensory information to the central nervous system and motor nerve fibers that send signals to skeletal muscle. The autonomic nervous system controls smooth muscle of the viscera (internal organs) and glands.

Peripheral neuropathy results from some type of damage to the peripheral nerves. Certain chemotherapy drugs can cause peripheral neuropathy such as vinca alkaloids (vincristine), cisplatin, paclitaxel, and the podophyllotoxins (etoposide and tenoposide).

Neuropathy can affect nerves that control muscle movement and those that detect sensations such as coldness or pain (sensory nerves). In some cases - autonomic neuropathy - it can affect internal organs, such as the heart, blood vessels, bladder, or intestines.

Pain from peripheral neuropathy is often described as a tingling or burning sensation. There is no specific length of time that the pain exists, but symptoms often improve with time. Sensory nerve damage can cause various symptoms, such as an impaired sense of position, tingling, numbness, pinching and pain and many report a sensation of wearing an invisible "glove" or "stocking." These sensations tend to be worse at night, and can become painful and severe. Sensory nerve damage may lead to a lessening or absence of sensation, where nothing at all is felt.

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There are a variety of treatments available for peripheral neuropathy. They range from traditional pills and creams to special diets and therapies that stimulate the nervous system. Antidepressants, especially tricyclics are a favored treatment for neuropathies. They will relieve neuropathic pain in non-depressed persons. Another class of medicines commonly prescribed for neuropathy is that of anticonvulsants. These medicines block calcium channels on neurons to limit pain. Opioid narcotic treatments for neuropathy are used as well to treat the condition, but are less favored because of the risk of dependency. However, opioids have been the most consistently effective in reducing pain.

Although some of the signs of neuropathy may appear suddenly, this change in sensation usually builds gradually and can worsen with each additional dose of chemotherapy. It is usually strongest right after a chemo treatment, but tends to lessen just before the next treatment. The symptoms usually peak about 3 to 5 months after the last dose of treatment is taken. The abnormal sensations may disappear completely, or lessen only partially; they may also involve less of the body. If neuropathy diminishes, it is a gradual process usually requiring several months. 

In some cases, a partial or full return to normal function is possible. The disorder is not usually associated with life-threatening complications, but it can be uncomfortable or disabling.

Physical therapy, occupational therapy and orthopedic interventions may be recommended. For example, exercises and retraining may be used to increase muscle strength and control. Wheelchairs, braces, and splints may improve mobility or the ability to use an affected arm or leg.

Safety is an important consideration for people with neuropathy. Lack of muscle control and reduced sensation increase the risk of falls and other injuries. The person may not notice a potential source of injury because he or she can't feel it. For example, one may not notice if water in a bathtub is too hot. For this reason, people with decreased sensation should check their feet or other affected areas frequently for bruises, open skin areas, or other injuries, which may go unnoticed and become severely infected. Often, a podiatrist can determine if special orthotic devices are needed.

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Disclaimer: These statements have not been evaluated by the Food and Drug Administration. The products and information contained herein are not intended to diagnose, treat, cure or prevent any diseases or medical problems. This is not intended to replace your doctor's recommendations. The information is provided for educational purposes only. Nutritional benefits may vary from one person to another.

 

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