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Nerve Damage after Chemotherapy (Peripheral Neuropathy)

What is peripheral neuropathy?

Peripheral neuropathy is a type of nerve damage in the hands and feet. This condition can be a side effect of some chemotherapy drugs.

Symptoms include pain, numbness, or tingling in the hands or feet. As nerve damage increases in the feet, the muscles may become weak and cause foot drop. This may cause an inability to lift the front of the foot and cause your foot to drag while you are walking.

Peripheral neuropathy cannot be cured. But your care team may be able to keep symptoms from getting worse.

Nerve damage caused by chemotherapy usually gets better after treatment ends, but some muscle weakness may last for a long time.

Symptoms of peripheral neuropathy

Peripheral nerves carry signals from the brain to the rest of the body.

These signals have different functions:

  • Motor (movement)
  • Sensory (pain, touch)
  • Autonomic (temperature, blood pressure)

Motor symptoms

  • Loss of balance or coordination
  • Change in walking that can cause you to trip or fall
  • Difficulty lifting the front of the foot. This is called “foot drop.”
  • Muscle weakness and loss of muscle bulk
  • Muscle cramps and muscle tightness
  • Problems with fine motor skills such as writing, tying shoes, or buttoning clothes

Sensory symptoms

  • Numbness, tingling, or a pins-and-needles feeling
  • Mouth or jaw pain
  • Not able to feel hot or cold
  • Not able to feel pain, such as a sore or a cut
  • Sharp, sudden, shooting pain
  • Constipation or trouble urinating
  • Mouth dryness

Autonomic symptoms

  • Constipation or trouble urinating
  • Decrease in sweating
  • Dizziness when standing up or moving too fast. This may cause fainting.
  • Dry mouth
  • Skin color changes
  • Body temperature control issues

Problems tend to start in the nerves farthest away from the spinal cord. This is why the hands and feet are most affected. Weakness tends to occur in legs before arms.

Causes of peripheral neuropathy

Chemotherapy medicines can harm nerves. Medicines that have the highest risk of causing nerve damage include:

Higher doses and combinations of medicines can increase the chance of nerve damage. Younger children may be more at risk because their nervous systems are still developing. Radiation therapy may also cause damage to the nerves in the field of radiation. This is quite uncommon.

Medical conditions such as diabetes can damage nerves and increase the risk of peripheral neuropathy. 

A doctor, testing the sensibility of a patient`s foot. This test is often used for checking neuropathy.

Your child's physical therapist may do sensory testing to see if your child has loss of feeling in their feet.

Diagnosis of peripheral neuropathy

To diagnose peripheral neuropathy, your child’s care team looks at the:

  • Type of symptoms
  • Severity of symptoms, such as pain. They look at how much the symptoms affect daily life.
  • Change in symptoms over time

Your child may have a neurological exam and other tests. A neurological exam measures reflexes, sensations, and nerve signals. Care providers may use a rating scale to label the grade, or severity, of nerve damage.

Your child may also see a physical therapist to help with diagnosis and treatment plans. A physical therapist may look at:

  • Muscle strength
  • Range of motion
  • Position or alignment of feet and ankles
  • Balance
  • Walking without shoes to look at foot position
  • Ability to sense touch and vibration
  • Reflexes

Your child’s care team may also do blood tests, spinal fluid tests, and imaging scans such as MRI or CT scans.

Treatment of peripheral neuropathy

Peripheral neuropathy cannot be cured. But you can manage it. Your child’s health care team can work with you to help prevent symptoms from getting worse.

If your child has peripheral neuropathy caused by medicines, the care team may update the treatment plan to reduce the risk for nerve damage. When possible, care providers try to:

  • Limit the dose of medication
  • Plan to have rest breaks
  • Avoid combinations of medicines that increase neuropathy risk

Sometimes symptoms get better after treatment ends. But symptoms may not completely go away. And new symptoms may develop later. These are late effects of treatment.

A health care provider may prescribe medicine to help with pain. Physical therapy and occupational therapy can help with problems such as pain, loss of feeling, and muscle tightness and/or weakness.

Types of treatment

Strategies may include:

  • Pain management: Your child’s care team may try different types of medicine for nerve pain. This could include an antidepressant, an anti-seizure medication such as gabapentin, and/or pain relievers such as opioids and lidocaine.
  • Rehabilitation support: This includes physical therapy and occupational therapy. Treatments may include:
    • Exercises to improve strength, range of motion, and balance
    • Mobility aids to help with walking, such as walkers, crutches, or canes
    • Devices such as arch or ankle supports to align joints and improve movement
    • Assistive devices to help with daily activities. This can include tools to help with writing, buttoning clothes, or brushing teeth.
    • Home exercises and family education 
  • Integrative medicine: Patients may find help from mind-body therapies such as massage, acupuncture, biofeedback, yoga, and other relaxation techniques. Talk to the care team before trying any new therapy to make sure it is safe.
  • Treatment for dizziness: Sometimes people with peripheral neuropathy may get dizzy when they stand up. This usually is due to a short-term drop in blood pressure. Treatments may include gradually sitting upright, increasing hydration, and taking medicines. If the patient faints, lay them flat and elevate their legs. They should then regain consciousness quickly.
Young female patient doing physiotherapy at a clinic with help of a therapist.

Your child may work with a physical or occupational therapist to help treat peripheral neuropathy symptoms.

Prognosis for peripheral neuropathy

Symptoms resolve and muscle weakness improves in most people with peripheral neuropathy. Disabling muscle weakness is uncommon.

Muscle weakness, changes in walking, and poor joint alignment can lead to long-term health problems. Knees, hips, and spine may become damaged over time. This causes pain and loss of function. And it can increase the risk of falls.

Peripheral neuropathy often leads to low levels of physical activity. This can cause or add to other health problems.

Managing peripheral neuropathy will improve your child’s quality of life. Follow your care team’s instructions. Attend follow-up appointments with the care team.

Tips for patients and families

  • Wear shoes that provide support but are not too tight: Look for rubber soles. Avoid shoes that make it easier to slip or fall. Avoid walking bare foot if foot drop is present.
  • Use devices such as splints or orthotics as prescribed by your care team: These tools help children take part in activities and maintain independence. The devices can also help with walking and prevent falls. Children may resist using the devices at first. But they will be able to move and play more normally. Check the fit regularly to prevent sores or blisters.
  • Protect hands and feet from injury: Loss of sensation can make it easier to get cuts or burns. Check regularly for blisters, scrapes, and cuts. Avoid walking barefoot.
  • Check the water temperature before washing hands or bathing: Loss of sensation can increase risk of burns when water is too hot.
  • Watch for problems in hot weather: Some patients may have more symptoms in the heat or have decreased sweating.
  • Be careful in dimly lit areas and on uneven surfaces to help reduce trips and falls: This includes areas with stairs, door thresholds, rugs, or cords lying on the floor.

Key points about peripheral neuropathy

  • Peripheral neuropathy is a type of nerve damage in the hands and feet. Some chemotherapy drugs cause nerve damage.
  • Symptoms may include pain, numbness, tingling, and muscle weakness.
  • Peripheral neuropathy cannot be cured. But you can manage it. Your child’s health care team can help prevent symptoms from getting worse.
  • Follow instructions that your child’s health care team gives about using assistive devices and tools. This can help the joints stay healthy and improve function.
  • Your child may have sensory, motor, and autonomic symptoms with peripheral neuropathy. This makes them more likely to fall or hurt themselves. Ask your care team about how to keep your child safe at home.

Reviewed: October 2023