Chemotherapy induced peripheral neuropathy (CIPN) is one of the more common side effects of cancer therapy. CIPN is generally thought to arise as a consequence of disruption of axoplasmic microtubule-mediated transport, distal axonal degeneration, and direct damage to the sensory nerve cell bodies of the dorsal root ganglia (1). (See diagram below) Symptoms generally start with a sense of numbness in the fingertips, toes and soles of the feet and may slowly progress to tingling and pain that can extend to the hands, arms, ankles and legs. Pain and discomfort vary from person to person but can become severe and debilitating affecting ones quality of life and ability to perform daily tasks.
Certain classes of chemotherapy drugs tend to cause CIPN. For a thorough list of these medications and other possible contributing factors go to:
http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/chemotherapyeffects/peripheralneuropathy/peripheral-neuropathy-caused-by-chemotherapy-how-does-cipn-start
Conventional Treatment Options
The best way to treat CIPN is to prevent it from occurring or progressing. Symptoms may resolve after completion of chemotherapy or may persist in some cases. Let your oncologist know as soon as you begin experiencing symptoms. Your doctor may choose to adjust your chemotherapy dose, delay treatment or even discontinue the causative medication. Ultimately, the goal is to prevent long-lasting harmful side effects while getting the optimal dose of recommended chemotherapeutic agents.
Managing CIPN with medications can be effective for symptom relief. Commonly prescribed treatments are steroids, pain creams, anti-depressants and anti-convulsants, narcotics or opioids. Often if symptoms are severe, multiple medications to manage symptoms may be prescribed. Physical and occupational therapy may also be recommended in some cases.
Alternative Therapies
Aside from the above treatments, other natural supportive therapies can be utilized in conjunction or alone to alleviate CIPN. Small studies using acupuncture to manage CIPN symptoms are showing positive outcomes. Studies have shown that after multiple acupuncture treatments, nerve conduction is improved in patients with CIPN (2). The Traditional Chinese Medicine treatment goal is to improve the flow of blood and qi to the extremities and improve blood, qi and yang deficiency in the body.
Nutritional supplementation may also have some benefit. Supportive evidence using L-glutamine, alpha-lipoic acid and L-carnitine have each shown some positive response with preventing or treating peripheral neuropathy. Protecting and healing the nerves is the mechanism of action with these supplements. If known peripheral nerve damaging chemotherapy medications are being prescribed, initiating these supplements before symptoms even start can help prevent it from occurring or can delay progression and intensity of nerve damage. Discuss with your naturopath and oncologist before taking these supplements as timing around chemotherapy is important to prevent interaction.
Supportive data on each of the supplements can be found at:
Glutamine: http://clincancerres.aacrjournals.org/content/7/5/1192.full
Alpha-lipoic acid: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772894/
Acetyl-L-Carnitine: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805703/
References
1. http://www.lwwoncology.com/Textbook/Content.aspx?aid=9826770
2. http://www.ncbi.nlm.nih.gov/pubmed/22146780
Image of nerve compliments of: https://thombiology30.wikispaces.com/file/view/nerve_diagram.jpg/311184500/431x299/nerve_diagram.jpg
Image of feet compliments of: http://www.google.com/imgres?imgurl=http://www.briandorfman.com/blog/wp-content/uploads/2013/03/047feet_468x611.jpg&imgrefurl
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