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Chemotherapy Side Effects
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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