Treating Neuropathy in Cancer Patients with Physical Therapy

Peripheral neuropathy is common among cancer patients who have been treated by chemotherapy.  This specific form of neuropathy is called “chemotherapy-induced peripheral neuropathy,” or CIPN. This article will explore the causes of CIPN and it also reviews options for treating neuropathy in cancer patients.

Common Neuropathy Symptoms

Neuropathy” simply means “nerve disease.”  It could involve pain, or could be lack of sensation (numbness), tingling, or muscle weakness.The most common type is “peripheral neuropathy,” which generally begins in the extremities (e.g. fingers and toes) and may progress up the limbs.  As one might expect, symptoms of neuropathy may include problems both of sensation and of control, such as:

“Extremity” Symptoms

  • Tingling or pins-and-needles sensation
  • Sharp, stabbing pain
  • Burning or shock-like sensations
  • Loss of sensation or complete numbness
  • Trouble with small motor skills such as writing, texting, and buttoning
  • Gripping problems (dropping things)
  • Clumsiness
  • Weakness

“Core” Symptoms

  • Oversensitivity to touch
  • Balance and coordination problems, which can Lead to stumbling or falling when walking
  • Differences in your sensitivity to temperature, making it harder to gauge heat and cold
  • Reduced reflexes
  • Swallowing difficulties
  • Jaw pain
  • Hearing loss
  • Constipation
  • Trouble urinating

To put it mildly, neuropathy can be a painful condition that interferes with the ability to concentrate, sleep, and enjoy daily activities.

Neuropathy Caused by Chemotherapy

According to some sources, peripheral neuropathy occurs in about 30-40% of chemotherapy patients  (some other sources and studies find an even higher number.)  This is called “chemotherapy-induced peripheral neuropathy,” or CIPN.  Some types of chemo are more neurotoxic than others, and therefore are more likely to induce CIPN.  An NIH study identifies these types of chemo as being particularly neurotoxic:

  • Bortezomib
  • Cisplatin
  • Docetaxel
  • Epothilones
  • Lenalidomide
  • Oxaliplatin
  • Paclitaxel
  • Pomalodomide
  • Suramin
  • Thalidomide
  • Vincristine

If you are already experiencing neuropathy and are taking one of these drugs, consider discussing other options with your oncologist.

Because cancer itself steals bodily resources, and because many cancer therapies also impair digestion, reduce appetite, and inactivate certain vitamins and minerals, the body has an even harder time repairing the damaged nerve cells.

Diabetes and HIV are also major causes of neuropathy, so if you are dealing with one of these complications as well as cancer, your chances might be higher and the need for proactive interventions is probably greater.  Don’t wait until symptoms develop!

Additionally, you should know that CIPN does not always occur in sync with the chemo.  Sometimes it is a short-term “side effect” during chemotherapy, which goes away after treatment ceases.  Other times, it never goes away, or the full effects may even appear years after the treatment.

Long-Term Risks to Neuropathy

Like most chronic conditions, neuropathy doesn’t age well.  In fact, nerve cells are some of the hardest cells in the body to repair.  If they are not irreparably damaged, nerves can repair or regenerate but at a very slow rate (~ 2mm per month). Left untreated, neuropathy tends to get worse, and to contribute to other kinds of problems.

In the first place, loss of sensation leads to loss of awareness.  It’s kind of like disabling the “check-engine light” in your car.  Not knowing you’ve injured your foot could mean you don’t treat a minor cut for a few days—until it’s already infected.

Also, loss of control increases risk of other types of injuries, including falling.  Falling during chemo is worse yet, since (see the upcoming blog post), chemo also increases risk of osteoporosis because it inhibits mineral uptake.  You have enough going on: you don’t need a broken wrist or hip right now!

Finally, muscle weakness can be a result.  This could manifest itself as cramps, twitching, stiffness, limping, and issues with speech or with swallowing (which can in turn lead to risk of choking).

Healing Neuropathy through Movement

To begin with, you should know that long nerve cells (like those in the limbs) are wrapped with what’s called a “myelin sheath.”

Myelin Sheathing Around an Axon (source)

The myelin sheath has a similar look and function to the flexible sheathing around electrical wires: it protects what is inside and keeps the signal contained, strong, fast, and uninterrupted by external influences.

In a wire, the sheath is made of rubber or vinyl; in your body, it’s made mostly of lipids (fats).  So, diets low in fat, or too high in the wrong types of fats, can contribute to neuropathy and similar issues.  Myelin is crucial not just for sensation and movement, but even for learning and memory. Getting the right kinds of fats can assist in nerve repair.  Which is important, because chemo and radiation produce free radicals which do damage to the myelin.

But, building or repairing myelin in the body requires a host of processes to be in place, all of which require their own vitamins, minerals, and other micronutrients—and of course oxygen.

Then, you also need to get all that good stuff to the tissues.  That requires blood flow.  And removing the waste products requires moving the lymph.  The heart pumps the blood; but movement pumps the lymph.  Which means you have to move!

As you can imagine, movement also “works out” the nerves, telling them they’re still needed and just generally making them feel loved.  At the same time, movement & exercise also work against muscle atrophy and osteoporosis, which tend to go along with cancer and its typical treatments.

So, knowing all of that, here’s a short (and incomplete!) breakdown of some treatments that might be worth trying.  Again, every case and everybody is different (and not every food, supplement, or ointment is of equal quality.)

If something on the list isn’t working for you, don’t get discouraged: keep trying, keep fighting.  And get some good advocates, researchers, and professional therapists who can help.  But there should be enough here to let you know that there is hope  and that CIPN is not something to which you have to surrender.

A Partial List of Neuropathy Treatments

Dietary Changes

  • Foods and supplements rich in omega-3 fatty acids – especially EPA and DHA (but ensure your source is tested for mercury)
  • Studies demonstrate that alpha-lipoic acid and other antioxidants, vitamins C & D + quercetin, curcumin, and many other dietary nutrients can improve neuropathy outcomes—either by healing nerves directly, or by reducing the damage the chemo or radiation is able to do.  Research and try these (preferably in real food when possible), but notify your doctor of any large changes to your diet or supplement regimen: some nutrients can interact poorly with chemo or other medications.

Topical Remedies

Lifestyle Changes

Physical Therapy (PT) as a Treatment for Neuropathy

As mentioned above, movement is an important element in any treatment regimen for treating neuropathy in cancer patients.  A well-informed physical therapist will also be able to advise you about, and lead you through, several other of the neuropathy treatments listed in the table above.

Your PT can assist you with selecting the therapies that are most likely to help in your specific situation.  These could include things like:

  • Massage
  • Modalities to stimulate nerve healing such as laser therapy or electrical stimulation
  • Exercise tailored for your body, and for any specific considerations you might have as a result of cancer surgery, for instance.  This could include:
    • Aerobic exercise
    • Flexibility exercise
    • Strengthening exercise
    • Balance exercise
  • Adjusting for any other physical or medical issues you may be experiencing.  For example, if you are also facing diabetes, you need a regimen that helps your CIPN without negatively adjusting your blood sugar.
  • Training in exercises and other practices you can do at home as you continue rehabilitation

In many cases, a single therapy or treatment produces good effects in many places in the body.  One simple example is this: proper exercise is not only good for avoiding/healing CIPN, it is also helpful for lymphedema (see my blog post about this) and for osteoporosis (next blog post!).

At Oncology Rehab and Wellness, we specialize in treating neuropathy in cancer patients. Our physical therapy team would love to meet you, hear about the symptoms you’re facing, and create a customized physical therapy plan to boost your recovery.

To learn more about exactly how PT can help you, our cancer rehab clinic phone is (703) 789-0367. Call us if you have questions or want to schedule an appointment.