Understanding and managing peripheral neuropathy

Peripheral Neuropathy

What blood cancer patients need to know about peripheral neuropathy and how to manage it.

Blood cancer treatment, or sometimes the disease itself, can cause peripheral neuropathy. It causes damage to nerves of the peripheral nervous system, which transmits  information from the brain and spinal cord to every other part of the body. It causes pain, numbness, tingling, swelling or muscle weakness in different parts of the body. It usually begins in the hands and feet and gets worse over time.

Types of peripheral neuropathy

There are three main types that are not mutually exclusive and can often overlap.

Sensory neuropathy leads to loss of temperature, increased pain and altered pressure sensations. It can result in a general sense of numbness, especially in the hands and feet. It may be described as pins and needles, shooting pains, hypersensitive to touch, or pain that will not go away.

Autonomic neuropathy leads to changes in sweat glands, moisture and texture in the skin. There can also be an inability to control muscles that expand or contract blood vessels to maintain safe blood pressure levels. This can lead to a lowered blood pressure with symptoms of dizziness, light-headedness, or even fainting when a person moves suddenly from a seated to a standing position. If the nerves located in the gut are affected then this can lead to diarrhoea, constipation or incontinence.

Motor neuropathy can lead to a loss of motor function, muscle weakness, decreased foot stability, painful cramps, muscle wasting and altered foot structure.

The peripheral nervous system

The peripheral nervous system is made up of all the nerves outside the brain and spinal cord including the nerves in the face, arms, legs, chest, and some nerves in your skull. It acts like an information highway with messages being sent and received through the nervous system to and from the brain.

When the nerves within the peripheral nervous system become damaged the messages they carry can become distorted or interrupted. This is what occurs in peripheral neuropathy.

What causes peripheral neuropathy in blood cancers?

There are numerous factors causing peripheral neuropathy:

  • Underlying causes such as diabetes, older age, excessive consumption of alcohol, kidney disease and other pre-existing autoimmune and inflammatory diseases.
  • Treatments such as thalidomide, Velcade (bortezomib) and vincristine (part of the VAD chemotherapy regime), can damage the nerve cells, particularly when given in high doses.
  • Paraprotein can be deposited on nerve tissue and damage the nerve cells. High levels of paraprotein can also lead to thickening of the blood, called hyperviscosity. This may reduce the circulation of the blood and can also lead to the symptoms of peripheral neuropathy.
  • Shingles.
  • AL amyloidosis or a previous diagnosis of MGUS (monoclonal gammopathy of unknown significance).
  • Myeloma can cause holes in bones which can lead to compression of nerves.
  • Amyloid deposits.

What are the symptoms?

  • Pain, which can vary in intensity and is often described as sharp, burning or jabbing.
  • Pins and needles may start in your toes or the balls of your feet and travel up your legs or start in your fingers and work its way up your hands and arms.
  • Unusual sensations or an increased sensitivity to touch.
  • Altered sensation, such as a feeling of pain or heat when touching something cold.
  • Numbness in your hands or feet. Muscle cramps, weakness and tremor, interfering with your ability to perform everyday tasks.
  • Lack of co-ordination or sense of proportion.
  • Loss of dexterity which interferes with simple tasks that require intricate movements of the fingers and hands, such as doing up buttons.

Treatment

Medication may help reduce pain in the feet, legs, and arms although it doesn’t bring back full sensation. Some over-the-counter painkillers may help, too.

Your doctor may prescribe medication that is used to treat other medical problems, such as epilepsy or depression, which can also have an effect on neuropathic pain. The drugs to prevent seizures include gabapentin, pregabalin, phenytoin, and carbamazepine. The antidepressant drugs may include amitriptyline or duloxetine. Injections of local anaesthetic such as lignocaine or topical patches containing lignocaine may relieve more intractable pain.

Your doctor may also refer you to a pain specialist or neurologist.

Active and passive forms of exercise can reduce cramps, improve muscle strength, and prevent muscle wasting in affected limbs. Massage may improve circulation which can reduce pain.

Supplements that may be helpful in managing the symptoms of neuropathy include:

  • vitamin B complex that includes B1, B6, B12 and folic acid.
  • magnesium.
  • amino acids including Acetyl-L-carnitine and Alpha-lipoic acid.
  • fish oils, omega-3 fatty acids (EPA and DHA), flaxseed oil.

Discuss taking any supplements with your doctor to ensure they are safe and don’t interact with other medicines.

10 self-management tips

  1. Take care of your hands and feet. Wear well-fitting protective shoes and keep hands and feet warm.
  2. Be careful when getting into the bath or shower and check the temperature of the water first.
  3. Do regular, gentle exercise to keep your muscles toned and to improve circulation.
  4. Low resistant bed clothing such as silk sheets can be more comfortable.
  5. Eat a well-balanced diet.
  6. Avoid falls by reducing the risks in your own home.
  7. Ask for a referral to an occupational therapist to look at possible assistive devices and assess any risks around your home.
  8. Adopt good posture and avoid sitting with legs crossed for long periods of time.
  9. Transcutaneous electrical nerve stimulation (TENS) machines can sometimes help reduce your level of pain by delivering tiny electrical impulses to specific nerve pathways.
  10. Complementary therapies such as acupuncture, reflexology and gently massage as well as relaxation techniques may all help to relieve some of your symptoms.

More on peripheral neuropathy

Watch a cancer care coordinator, Carmel, talk about peripheral neuropathy. She spoke to a group of myeloma patients at last year’s Leukaemia Foundation National Myeloma Day event.

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