Understanding Chemotherapy-Induced Peripheral Neuropathy (CIPN)

Chemotherapy is a powerful and often life-saving treatment for cancer, but it can come with a range of side effects. One of the more challenging and sometimes long-lasting complications is Chemotherapy-Induced Peripheral Neuropathy (CIPN).

CIPN affects the nerves outside the brain and spinal cord—called peripheral nerves—and can significantly impact quality of life during and after cancer treatment.

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What Is CIPN?

Peripheral neuropathy refers to damage or dysfunction of the peripheral nerves, which are responsible for transmitting signals between the central nervous system and the rest of the body (like the arms, legs, hands, and feet).

When this damage is caused by chemotherapy, it’s called Chemotherapy-Induced Peripheral Neuropathy (CIPN). It’s a common side effect of several chemotherapy drugs, including:

• Platinum-based agents (e.g. cisplatin, oxaliplatin)

• Taxanes (e.g. paclitaxel, docetaxel)

• Vinca alkaloids (e.g. vincristine)

• Bortezomib (used in multiple myeloma)

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Symptoms of CIPN

CIPN can affect sensory, motor, and autonomic nerves, leading to a wide range of symptoms. These often start in the hands and feet and may include:

• Tingling or “pins and needles”

• Numbness or reduced sensation

• Burning or shooting pain

• Muscle weakness or cramping

• Difficulty with balance or coordination

• Increased sensitivity to temperature or touch

• Fine motor difficulties (e.g. buttoning clothes, writing)

Symptoms can appear during treatment or weeks to months after and may gradually improve—or in some cases, persist long term.

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How Common Is CIPN?

It’s estimated that 30% to 70% of patients undergoing chemotherapy will experience some level of CIPN. The severity and duration can vary depending on:

• The type and dose of chemotherapy

• Length of treatment

• Individual risk factors (e.g. diabetes, age, alcohol use)

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Management and Treatment Options

Unfortunately, there is no single cure for CIPN, but several strategies can help manage symptoms and improve function:

🔹 Medication

• Certain medications (e.g. duloxetine) may help reduce nerve pain.

• Over-the-counter pain relievers or topical treatments may provide some relief.

🔹 Physical and Occupational Therapy

• Tailored exercises can help improve balance, strength, and coordination.

• Occupational therapy can assist with adapting to daily activities and fine motor tasks.

🔹 Podiatry and Foot Care

• Podiatrists play a crucial role in managing foot-related symptoms of CIPN.

• Regular foot assessments, gait analysis, and custom orthotics may help prevent injury and reduce pain.

• Education on footwear, hygiene, and injury prevention is vital, especially for those with reduced sensation.

🔹 Lifestyle Modifications

• Avoiding extreme temperatures

• Protecting feet and hands from injury

• Practicing good foot and skin care

• See Dietician/Nutritionist

• Regular bloodwork to check for vitamin and nutrient deficiencies. Particularly Vitamins B1,B6,B12, folate, magnesium, Vit D as they can be linked to nerve conduction. However, only take supplements under medical supervision, especially during cancer treatment.

🔹 Complementary Therapies

• Some patients find relief with acupuncture, massage, or transcutaneous electrical nerve stimulation (TENS), though evidence varies.

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Can CIPN Be Prevented?

Prevention is a key area of research. At present, no medications have been definitively proven to prevent CIPN. Oncologists often monitor symptoms closely and may adjust chemotherapy doses to reduce the risk of permanent nerve damage.

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When to Seek Help

If you’re undergoing chemotherapy and begin experiencing symptoms like tingling, numbness, or difficulty with daily tasks, it’s important to speak to your oncology team as early as possible. Early intervention can help prevent worsening symptoms and improve long-term outcomes.

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Living with CIPN

CIPN can be frustrating and even debilitating, but support is available. Whether through medication, physical therapy, podiatry, or community resources, there are ways to manage the condition and maintain quality of life.

You're not alone—many people live full and active lives despite the challenges of CIPN.

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If you're concerned about CIPN, speak with your doctor, podiatrist, or allied health professional.

A collaborative care team can help you find the right approach for your needs.