Tips For Preventing & Treating Chemo-Induced Peripheral Neuropathy (CIPN)
WHAT IS CIPN?
Peripheral neuropathy is a set of symptoms caused by damage to the distal nerves – nerves that are away from the brain and spinal cord. With cancer, certain chemotherapy drugs – namely the taxanes and platinum based drugs – can cause peripheral neuropathy and this is known as “chemo-induced peripheral neuropathy” or CIPN. It is quite common, affecting 40% of people undergoing chemotherapy.
The neuropathy typically begins in the fingers and toes and moves upward as the condition worsens. Symptoms can vary in type and severity ranging from tingling, burning, pain, numbness and even loss of motor control. These symptoms can result in loss of balance, shooting or stabbing pains that can come and go or altered sensation (either with greater sensitivity or lack of sensitivity) to touch, pressure and temperature. Symptoms may start in the fingers and/or toes and move upward as the condition worsens. It can also cause muscle weakness and loss of muscle mass, making it difficult to walk, pick up objects or even to hold onto things like a cup or handrail, increasing the likelihood of a fall, which of course to lead to a whole set of other problems.
HOW LONG CAN CIPN LAST?
CIPN can last for a very short time or it can be longer lasting and quite severe. Sometimes, the CIPN becomes sufficiently severe and persistent that it requires a pause or complete cessation of chemotherapy. Therefore, not only can CIPN have significant affect on your quality of life, it can be a treatment-limiting side effect and thereby compromise treatment outcomes. For these reasons, it is important to look at what causes CIPN and how it can be prevented or treated.
WHAT CAUSES CIPN?
There are certain types of chemo drugs that are more likely to cause PN, such as the platinum drugs (cisplatin, carboplatin and oxaliplatin), taxanes (paclitaxel, docetaxel) and even some of the targeted chemo agents such as Bortezomib.
There are other potential causes of peripheral neuropathy that should be considered. These factors may exacerbate the severity of CIPN. Other causes of neuropathy include low B vitamin levels, diabetes, poor circulation, infections, other medications, surgery-induced injury to nerves, or nerve compression from tumors. Some of these factors can be co-treated or addressed prior to beginning chemotherapy to reduce the risk for CIPN – for example, if a B vitamin deficiency is suspected, taking certain B vitamins prior to and even during chemotherapy may help. If type II diabetes is present, ensuring proper glucose control prior to and during chemotherapy may be an important preventative measure.
CAN CIPN BE PREVENTED?
Certainly, the healthier you are prior to beginning chemotherapy the less likely you will develop CIPN and the shorter the duration of the neuropathy. Stay as active as you can before and during treatment, and avoid alcohol and sugars – especially if you have diabetes since high levels of glucose in the blood can also damage nerves.
Studies on preventative measures for CIPN have largely focused on the use of natural compounds. Agents such as acetyl-L-carnitine, glutathione, alpha lipoic acid, calcium, magnesium, and certain B vitamins can have variable impact on CIPN and studies have produced mixed results. There is better efficacy using a combination approach of treatment and achieving optimal doses of the individual agents. Note that some of these agents may interfere with chemotherapy, underscoring the importance of seeking the guidance of a clinician with an expertise in integrative or naturopathic cancer care before taking any supplements before, during or after cancer treatment.
WHAT ARE THE TREATMENTS FOR CIPN?
Conventional therapies for CIPN are directed at treating the pain to make the symptoms more manageable. These include a short-course of steroid therapy, numbing creams or patches to apply to the affected area, anti-depressant medication or anti-seizure medication such as gabapentin – which can sometimes help numb the pain. The effectiveness of these interventions is variable.
Other treatments that may manage the discomfort include meditation, CBT, hypnosis and guided imagery techniques.
The most effective treatment appears to be low-level laser therapy (also known as cold laser therapy). Results of a study published in the Journal of Clinical Oncology in 2012, found that all 20 patients in the treatment group had significant improvement compared to the placebo-control group.
The cold laser therapy is applied directly to the affected areas for 15-60 minutes at a time, depending on the affected region. The earlier this treatment is begun, the more effective it is at treating CIPN. It appears to work by reducing inflammation of the nerves, and by increasing local serotonin levels and improving circulation to the area, thereby expediting the healing process. There are no side effects and no contraindications to cold laser therapy. Number of treatments required depends on the severity of the condition – as little as 4 or as many as 16 treatments may be required. When coupled with other interventions, such as diet and nutritional support, there is even greater effectiveness of cold laser therapy.
Cold laser therapy is most effective in the early stages of PN. Keep in mind that an approach that works for some, may not work for all. It’s possible that the most effective intervention may be a combination approach of several types of treatment for CIPN. Sometimes it requires a bit of trial and error to find the effective formula for treatment, but rather than self-treat, seek the counsel of a medical professional who is knowledgeable in this area.