irritation or damage to nerves outside causes difficulty ... · peripheral neuropathy author:...
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![Page 1: Irritation or damage to nerves outside Causes difficulty ... · Peripheral Neuropathy Author: Evelyn Created Date: 8/6/2015 6:33:07 PM](https://reader033.vdocuments.us/reader033/viewer/2022052016/602e7a2d5fe98c38ee44d158/html5/thumbnails/1.jpg)
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Irritation or damage to nerves outside
the brain and spinal cord
Causes difficulty in communication
between nerves or group of nerves
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Long, wire-like fibers
Transmit nerve impulses and sensory
information from the body to the spinal
cord
Carry motor signals for muscle
movement and other functions from the
brain and spinal cord to rest of body and
organs
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Chronic diabetes and uremia
Infection which affects nerves such as
shingles (post herpetic neuralgia)
Excess alcohol
Tumor pressing on a nerve
Spinal cord injury
Low vitamin B levels (especially B12)
Poor circulation
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Damage to nerves can occur with:
› Surgery
› Radiation therapy
› Chemotherapy
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Can cause damage to nerves near the
surgical site
Side effects reported with damage:
› Burning
› Shooting pain
› Electric tingling
› Numbness in skin around surgical site
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More common in 1960s with older
treatments
Much less common today but still can
occur
Side effects can include:
› Weakness
› Pain
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Polyneuropathy most common form of
neuropathy (affects several nerves)
Usually affects both sides of the body
equally
Symptoms usually begin in feet and can
progress to hands (referred as
“stocking/glove distribution”)
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Platinums (cisplatin, carboplatin, oxaliplatin)
Taxanes (Taxol or paclitaxel, Taxotere or docetaxel)
Epothilones (Ixabepilone or Ixempra)
Plan alkaloids (vinblastine, vincristine, vinorelbine, etoposide)
Thalidomide and lenalidomide (Revlimid)
Bortezomib (Velcade)
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Pain (can be constant or come and go,
shooting, electric or stabbing)
Burning
Tingling (“pins and needles”)
Numbness (decreased sensation of
pressure, touch, temperature)
Increased sensitivity to temperature
(especially cold), touch or pressure
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Difficulty using fingers to pick up, hold or
handle things such as buttons, writing
Problems with balance
Tripping or stumbling with walking
Shrinking or weak muscles
Loss of or reduced reflexes
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Difficulty swallowing
Urinary incontinence
Constipation
Impotence
Dizziness with standing
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3-7% in those treated with single agents
38% in those treated with multiple agents
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Can begin anytime after treatment starts
Sometimes occurs at end of treatment
Can worsen as treatments go on
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Can be short term
› Last a few days
› Stop after treatment ends
Can be long term
› Persist between treatments
› Continue 6-24 months after treatment ends
Can become a permanent problem
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Age
Genetic predisposition
Chronic conditions (diabetes, kidney failure, HIV)
Amount of each dose of chemo
Total dose of chemo
Drug combination
Previous chemo
Previous problems with PN
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Talk to your doctor or nurse immediately
after symptoms begin
Do not delay telling
Failure to disclose symptoms can lead to
life-altering problems
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Reduce dose of chemo (this is safe and
still give you the same benefit as higher
doses)
Give smaller doses 2-3X vs. 1X per week
Give dose over longer period of time
Give longer breaks between chemo
Alter chemo cycle
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Wear gloves and warm socks especially in the cold
Wear shoes inside and outside your home
Protect your hands when working
Keep your house well lit/keep night light
Use nonskid surface in shower/tub
Clear floor of objects and watch for rugs
Test temperature of water with non-affected body part
Check your feet at end of each day
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Avoid alcohol
If diabetic, control your blood sugar
Treat your pain as prescribed
Pay attention to your shoes
Sit down as much as possible if feet are a
problem
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Several preventions and treatments
have been tried with mixed results
There is no sure way to prevent CIPN to
date
Mixed results with treatments
Research needs to continue
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Antioxidant
May protect nerves from damage due to cytotoxic drugs
3 studies examined effect giving 300 to 600 mg during and 3 mths after treatment ended
Evidence of less nerve damage in group who took Vitamin E
Other study found deficient Vitamin E levels in pts receiving cisplatin who had PN
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Tested in pts who received oxaliplatin
which binds to calcium and magnesium
Given 1g of calcium and magnesium
before and after infusion
65% of those treated vs. 37% of non-
treated had no PN symptoms
Retrospective, nonrandomized study
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Amifostine which detoxifies
chemotherapy drugs and facilitates DNA
repair
Three studies examined effect on PN
No differences in sensory or motor
symptoms found in pts treated with
amifostine
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Carbamezapine (Tegretol) with
oxaliplatin
No neuropathy in treated group vs. 30%
in historical control group
Need placebo controlled trial
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Nonessential amino acid
Thought to have neuroprotective effects
for paclitaxel
8% of those treated vs. 40% not reported
PN symptoms in one study (10g daily)
Other study (10 g 3X/d) in those treated
noted less symptoms
Larger, randomized, placebo studies
needed
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Thiol tripeptide may hamper platinum accumulation in nerves
Three studies to date
1st 1500 mg/m2 IV, no grade 3-4 toxicity
2nd 3 g/m2, 58% vs. 39% able to receive all cycles of chemo and improved QOL
3rd 1.5 g/m2 17 vs. 88% had clinical evidence of PN
Need further randomized trials
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Fatty acid which converts sugar into energy and is also an antioxidant
Some studies with diabetics
4 randomized, double-blind, placebo controlled studies
600 mg/d IV
Clinically significant improvements in pain, burning and numbness after 5 wks
Need studies for CIPN
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Nutritional supplement which functions
as an antioxidant
2 studies in pre-existing CIPN
1 g/d IV or 1 g/tid orally
Studies limited by small sample size and
not randomized
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Nortriptyline – blocks reuptake of
serotonin and norepinephrine in pain
modulating system of CNS
Analgesic effect
Escalating dose of up to100 mg/d
Modest benefit in study of cisplatin
induced PN
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Antidepressants (amitriptyline,
nortriptyline, and desipramine)
Anticonvulsants (gabapentin or
Neurontin, pregabalin or Lyrica)
Steroids (short term use only)
Local anesthetics (capsaicin, EMLA,
lidocaine 5%)
Opioids and methadone
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Only ones approved by FDA for
treatment of neuropathic pain
› Duloxetine (cymbalta) – diabetic PN
› Pregabalin (lyrica) – diabetic PN and post
herpetic neuralgia
› Lidocaine patches 5% - post herpetic
› Gabapentin (neurontin) – post herpetic
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Acupuncture
Assistive devices
Physical activity and exercise
Pulsed infrared light therapy
Transcutaneous nerve stimulation
Spinal cord stimulation
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Relaxation therapy
Guided imagery
Distraction
Biofeedback
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PT - can help improve balance, strength and safety
OT – can help improve fine motor coordination such as writing and help adapt your home and work environment
Pain specialists – can educate you about treatment options and help manage your symptoms
Podiatrist – can help you find the right shoes for your symptoms
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Talk to your oncology team
Consider support groups
Visit respected internet websites
› cancer.gov
› cancer.org
› neuropathy.org
› cancercare.org
› lbbc.org
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Don’t suffer in silence