Peripheral Neuropathy

Peripheral neuropathy is a disorder of the peripheral nerves, which are the nerves outside the brain and spinal cord. These nerves control the sensations and movements of the arms and legs, and some control involuntary functions such as digestion and breathing. There are three types of peripheral nerves: 

  • Sensory nerves help you feel pain, heat, cold and pressure
  • Motor nerves help your muscles to move
  • Autonomic nerves control functions such as blood pressure, digestion, heart rate, temperature and urination

The signs of peripheral neuropathy depend on the types of nerves affected. Usually, sensory nerves are affected, and the signs typically begin at a point on sensory nerve fibers that are farthest from the center of the body (your fingers and toes) and gradually affect your feet and hands. These signs include:

  • Numbness and tingling (“pins and needles”)
  • Decreased sensation of hot and cold
  • Unpleasant sensations when touched
  • Muscle weakness and cramping
  • Balance problems
  • Ringing in ears or loss of hearing
  • Changes in vision
  • Constipation or difficulty urinating
  • Sexual health issues

Pain may also occur and usually has a burning or electric shock-like feeling. These symptoms may make it difficult to carry out normal activities, such as buttoning clothes, picking up small items or writing. Muscle weakness and balance problems may cause an unsteady gait or difficulty with walking.

What causes peripheral neuropathy?

It is the result of damage to sensory nerves, which may be caused by chemicals in chemotherapy or targeted therapy drugs. Other causes include tumors pressing on nerves, infections that affect nerves, spinal cord injuries, diabetes, alcohol abuse, shingles, low vitamin B levels, some autoimmune disorders and poor circulation. Knowing the cause of your peripheral neuropathy will help your health care provider determine the right treatment for it.

When does peripheral neuropathy occur?

Peripheral neuropathy caused by chemotherapy or targeted therapy drugs can be either acute (short term) or chronic (long term). Acute peripheral neuropathy usually begins during or shortly after administration of the drug and most often goes away on its own after several days. Chronic peripheral neuropathy may arise weeks or months after treatment and is sometimes irreversible. Whether peripheral neuropathy is acute or chronic depends on many factors, primarily the dose and combinations of drugs and the total dose of a drug given over time.

How you can help manage it

You can manage it in a variety of ways: with substances to protect against damage caused by drug therapy, exercises to ease discomfort and strengthen muscles, and treatments and medications to relieve pain.

In some cases, a substance known as a chemoprotective agent may be given prior to or with a chemotherapy drug likely to cause peripheral neuropathy.

Other treatments may include occupational therapy, physical therapy, relaxation therapy, guided imagery, acupuncture, massage and biofeedback.

Another strategy that may help to relieve pain in some people is transcutaneous electrical nerve stimulation (TENS). TENS involves a small electrical device with wires attached to the skin with electrodes; the device transmits a gentle current into areas of pain and stimulates the release of endorphins, the body’s natural painkillers.

Some medications that relieve pain include corticosteroids, topical medications (such as a lidocaine patch), and opioids or narcotics for severe pain. Antidepressants may relieve pain related to damaged nerves.

Stretching can help decrease pain related to neuropathy, especially in the morning. Moving your hands and feet in all directions before you get out of bed in the morning may be helpful, and strengthening your muscles with isometric exercises (exercises in which you hold a muscle in a flexed position for a period of time) can help you maintain balance and walk normally.

Your health care provider may suggest that you see a physical or occupational therapist to help with strengthening exercises and finding ways to carry out everyday tasks with less discomfort.

Other simple strategies include avoiding snug shoes or socks and extreme temperatures as well as taking part in regular exercise, such as walking. Take safety precautions, as the decreased sensation in your hands and feet may increase the risk for injury.

Safety tips to prevent accidental injury due to peripheral neuropathy:

  • Use caution when handling sharp objects.
  • Wear protective gloves when doing household repairs or yardwork/gardening.
  • Use potholders when cooking.
  • Do not walk inside or outside with bare feet. Always wear rubber-soled shoes.
  • Inspect your hands and feet on a regular basis for any breakdown in the skin. Keep skin moist with lotion to avoid cracking and peeling.
  • Remove obstacles in your home that could lead to injury (power cords, throw rugs, etc.)
  • Use an assistive device (cane, walker or wheelchair) if your gait is unsteady.
  • Use nightlights to keep areas of your home well lit.
  • Wear warm gloves, hats and scarves during cold weather.
  • Test the temperature of water with a non-affected body part before exposing affected areas.
  • DO NOT DRIVE if you are not able to feel the gas pedal or brake with your feet.

When to call your health care provider

Call when you first experience symptoms of peripheral neuropathy because early treatment offers the best chance of managing it. Some people have peripheral neuropathy prior to treatment due to having diabetes. If this is your situation, make sure your provider is aware of it before starting treatment.