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Peripheral Neuropathy Caused by Chemotherapy

Peripheral neuropathy is caused by damage to the nerves that are further away from the brain and spinal cord, such as in the feet and hands or bladder and bowel. Some chemotherapy drugs used to treat cancer cause damage to the peripheral nerves, a condition called chemotherapy-induced peripheral neuropathy (CIPN). This can be a disabling side effect of cancer treatment. It would be ideal to prevent CIPN before it occurs; however, because many patients already have CIPN, finding effective treatment is also very important.

Several commonly used types of chemotherapy – including platinum drugs, taxanes, and vinca alkaloids – can lead to CIPN, which occurs in 30 – 40% of patients. The degree of nerve damage depends on many factors, including the type and duration of chemotherapy, cumulative dose, and other drugs that are taken. The most common symptoms of chemotherapy-induced peripheral neuropathy are:

  • Pain, may be persistent or may come and go, like shooting or stabbing pain
  • Burning or tingling
  • Loss of feeling or decreased ability to sense touch, heat, or cold
  • Balance problems and trouble walking
  • Muscle weakness or decreased reflexes
  • Trouble swallowing
  • Constipation or difficulty passing urine
  • Blood pressure changes

Vitamins, supplements, substances made by our bodies, and drugs are being investigated to see if they can protect nerve cells from chemo damage if taken before, during and after chemo. More research is needed, but vitamin E, omega-3 fatty acids, N-acetylcysteine (NAC) and glutamine show promise.

The goal of CIPN treatment is to ease the symptoms. Sometimes the symptoms of CIPN are short-term and fade away after treatment is done. In some cases, it can take years. Severe CIPN may never disappear.

Treatment often focuses on pain relief. Researchers are investigating which drugs work best to relieve neuropathic pain. For example, the anti-seizure drug carbamazepine is being studied to see if it can help prevent or treat CIPN. It may take more than one try to find out what works best for you.

Compounded medications have provided relief for many types of neuropathy, and can be customized to contain the medications and doses that are most appropriate for each individual. A double-blind, placebo-controlled trial compared a compounded preparation containing baclofen 10 mg, amitriptyline HCL 40 mg, and ketamine 20 mg in a pluronic lecithin organogel (BAK-PLO)) to a placebo for the treatment of CIPN. These three drugs were chosen because they work in different ways to help pain, and their actions complement one another. The patients that received the BAK medication showed a greater reduction in tingling, cramping, and shooting/burning pain in the hands, with no apparent side effects.

We work together with patients and their doctors to customize medications and solve problems that have not responded to traditional therapies. Our pharmacist will be happy to answer your questions.

References: Neurology. 2010 Mar 2;74(9):762-6.
BMC Cancer. 2012 Aug 15;12:355.

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