Numbness and Tingling (Peripheral Neuropathy)
Numbness and tingling of your extremities (hands and feet) is called peripheral neuropathy and is caused by damage to the nerves between the extremities and the central nervous system (CNS). Some chemotherapy drugs can cause peripheral neuropathy. If you have numbness and tingling in your fingers or toes, you should notify your doctor immediately. Treatment for peripheral neuropathy that is caused by chemotherapy is to stop the therapy or change to a different drug that does not cause damage to the nerves. If immediate steps are not taken at the onset of symptoms, peripheral neuropathy can become a long-term problem.
What is peripheral neuropathy?
Peripheral neuropathy is damage to the nerves that transmit signals between the extremities and the central nervous system. These nerves include those that transmit sensation from the extremities to the CNS or those that carry signals for muscle movement from the CNS to the extremities. Depending on the type of nerve damage, the patient may fully recover without residual effects or may partially recover but have long-term deficits in their ability to feel or move. If severely affected, the patient may develop chronic muscular weakness and atrophy.
What causes peripheral neuropathy?
There are many possible causes of numbness and tingling. Some of the more common of these include:
- Uremia (too much urea in the blood due to kidney problems)
- Severe malnutrition
- Trauma, such as broken or dislocated bones
- Certain medicines or toxic substances
The chemotherapy and other cancer drugs that may cause symptoms are listed in table 1.
Table 1 Cancer drugs that have been reported to cause peripheral neuropathy in more than 10% of patients
|Drugs that cause peripheral neuropathy in 30% of patients or more
||Drugs that cause peripheral neuropathy in 10-29% of patients
- Arsenic trioxide (Trisenox®)
- Bortezomib (Velcade®)
- Docetaxel (Taxotere®)
- Oxaliplatin (Eloxatin®)
- Paclitaxel (Taxol®)
- Denileukin diftitox (Ontak®)
- Interferon alpha (Intron®)
- Tretinoin (Vesanoid®)
- Vinorelbine (Navelbine®)
- Alemtuzumab (Campath®)
- Altretamine (Hexalen®)
- Capecitabine (Xeloda®)
- Carboplatin (Paraplatin®)
- Cisplatin (Platinol®)
- Dacarbazine (DTIC-Dome®)
- Fludarabine (Fludara®)
- Liposomal daunorubicin (DaunoXome®)
- Vinblastine (Velban®)
- Vincristine (Oncovin®)
What are the symptoms of peripheral neuropathy?
In addition to numbness and tingling, other symptoms of peripheral neuropathy include weakness, pain in the arms, hands, legs and/or feet, and abnormal sensations such as burning, tickling, pricking or tingling, also known as paresthesia.
The areas of the body most commonly affected by peripheral neuropathy are the fingers and toes. Symptoms usually start at the end of the extremity and gradually move upward. Bowel function may also be compromised, causing or worsening constipation and eventually causing blockage of the intestines.
What can be done about peripheral neuropathy?
If you have symptoms of peripheral neuropathy, you should notify your doctor immediately. Treatment for peripheral neuropathy that is caused by chemotherapy is to stop the treatment or change to a different drug that does not cause damage to the nerves. If immediate steps are not taken at the onset of symptoms, peripheral neuropathy can become a long-term problem.
Recovery from peripheral neuropathy is usually slow, but steps can be taken to encourage regeneration of the damaged nerves. Some approaches include acupuncture, massage, physical therapy and transcutaneous nerve stimulation.
Acupuncture: A technique originating thousands of years ago in the Chinese culture, acupuncture uses thin needles inserted into the body at certain points. Each point controls the energy, called ‘Chi’ in Chinese medicine, in different parts of the body. These points also appear to control sensation, such as pain or numbness. Acupuncture has been shown to relieve pain associated with peripheral neuropathy.1
Massage: By increasing blood flow, massage may provide pain relief associated with peripheral neuropathy.2
Physical therapy: Through range of motion and stretching exercises, physical therapy may strengthen muscles that are weak and improve other symptoms of peripheral neuropathy.
Transcutaneous nerve stimulation (TNS): Through the use of a special device that transmits electrical impulses through electrodes attached to your skin, TENS has been shown to provide pain relief3 and may promote nerve regeneration.4
Chavez C. Prickly business. The finer points of acupuncture. Posit Aware. 1995 Jan-Feb:14-5.
2 HIV neuropathy. Proj Inf Perspect. 1997 Jul; (22): 12-3.
3 Ghoname EA, Craig WF, White PF, et al. Percutaneous electrical nerve stimulation for low back pain: a randomized crossover study. JAMA. 1999;281:818-823.
4 Mendonca AC, Barbieri CH, Mazzer N. Directly applied low intensity direct electric current enhances peripheral nerve regeneration in rats. J Neurosci Methods. 2003 Oct 30; 129(2): 183-90.