Peripheral neuropathy is a complex condition that can cause many different symptoms. This is because the damage can be to any part of the peripheral nervous system, which includes sensory nerves, motor nerves and the autonomic nervous system.
Often more than one type of nerve is affected. Symptoms are usually mild in the beginning, but can get worse over time for some people.
Sensory nerves send messages from the body to the brain, carrying information about pain, temperature, touch, vibration, and where the body is in space, which is important for balance and coordination.
Symptoms of sensory nerve damage may include:
- not being able to feel your hands or feet (numbness)
- tingling ('pins and needles') in hands or feet
- pain in hands or feet – these may be burning or shooting pains, 'like walking on hot sand'
- feeling light touch as pain, especially at night
- confusion about temperature, e.g. feeling heat as cold, or not being able to tell if something is hot or cold
- loss of awareness of where your body is in space, making you feel clumsy, especially when walking on uneven surfaces
- trouble keeping your balance when walking
- loss of hearing, or ringing in the ears (tinnitus).
Motor nerves carry messages from the brain to the muscles to control movement. Symptoms of motor nerve damage may include:
- finding it hard to do up buttons or pick up small objects
- trouble walking up stairs or getting up out of a chair
- muscle loss
- weakness, e.g. not being able to open a jar
- muscles twitching under skin
- poor handwriting
- unsteady way of walking (gait).
Autonomic nervous system
The autonomic nervous system carries messages between the internal organs and the brain. It controls processes that happen automatically, including blood pressure, heart rate, temperature control, digestion, and bowel and bladder functioning.
Symptoms of autonomic nervous system damage may include:
- feeling bloated
- dizziness when changing position from lying down to sitting up, or from sitting to standing
- blurred vision
- trouble getting or keeping an erect penis.
The impact on quality of life
Peripheral neuropathy can affect someone's quality of life in many ways. The impact varies from one person to another, but it can include:
- discomfort and pain from physical symptoms
- trouble completing everyday tasks because of finger numbness and loss of fine motor control
- high risk of scalds and cuts because of numbness – in addition, chemotherapy often lowers your resistance to infection, so minor burns and cuts can quickly become serious
- risk of not noticing injuries, which may become more serious because they aren’t treated promptly
- difficulty walking because you have numbness or pain in your feet, you find it hard to keep your balance and/or you can’t sense where your feet are in relation to the ground
- high risk of falls because of numb feet, dizziness, balance problems and difficulty sensing where your body is in space
- poor sleep because of shooting pains
- not being able to drive because of numb feet and difficulty sensing where your body is in space
- not being able to return to work or other activities
- feeling isolated if it is hard to move around
- money issues because of health care costs
- feeling that you have lost your independence.
It is important to tell your treatment team if you start having any symptoms or notice a change in your symptoms.
Adjusting your cancer treatment may allow the nerves to recover and avoid permanent damage. Your team can also check whether anything else is causing the symptoms.
Tips for looking after yourself
Many people find ways to adapt to life with peripheral neuropathy. These suggestions may help reduce the impact of the symptoms on your quality of life:
Protect hands and feet
- Wear gloves when washing the dishes or gardening
- Use heatproof potholders when cooking
- Test water temperature with your elbow
- Keep your hands and feet warm
- Moisturise your hands and feet and keep your nails trimmed
- Make sure your shoes fit well.
- Take your time standing up
- Drink plenty of fluids
- Wear support stockings during the day to improve your circulation
- Sit down when brushing teeth or putting on shoes.
- Keep rooms well lit
- Reduce clutter and remove loose rugs
- Use non-slip mat in shower and bath
- Place rails on stairs and in bathrooms
- Talk to your doctor about falls prevention programs.
- Try silk or bamboo sheets if your feet are sensitive
- Use a special frame to keep sheets off your feet.
Check about driving
- Ask your doctor whether it is safe for you to drive.
A range of health professionals can help you manage peripheral neuropathy. They may suggest the following:
Medicines to manage symptoms
Doctors use various medicines to help relieve peripheral neuropathy symptoms. These may include:
- pain medicines – try over-the-counter painkillers (e.g. paracetamol, ibuprofen) but these often don’t help much. Your doctor may prescribe stronger pain medicines (e.g. tramadol), but the side effects may mean that these are not a good long-term solution.
- duloxetine – sometimes this antidepressant is recommended. While some studies have shown that it helps relieve numbness, tingling and pain, other studies have found no benefit.
- other drugs – because treatment options are limited, some other types of antidepressants, the anticonvulsant gabapentin, and the topical creams capsaicin or lignocaine are sometimes recommended by doctors, but the evidence is not clear.
- laxatives or stool softeners – these can help manage constipation.
Other ways to relieve symptoms
Although there are few medicines that can help with peripheral neuropathy, there are other ways to relieve symptoms and reduce the risks:
- exercise – to strengthen muscles, improve circulation, reduce pain and cramps, and improve balance. A physiotherapist or exercise physiologist can help develop an exercise program for you.
- equipment – to help manage daily tasks and reduce the risk of falls, an occupational therapist can recommend appropriate aids, equipment and strategies.
- foot care – peripheral neuropathy can make it difficult to look after your feet. A podiatrist is a trained health professional who can trim your toenails, treat any skin problems and check your feet for injuries you may not have noticed.
- pain relief without medicine – nerve pain can sometimes be relieved with massage, while learning relaxation techniques can help manage pain and discomfort. Some people find magnesium cream and tablets can help ease muscle cramps in the feet and lower legs.
- psychology and counselling – a psychologist can teach relaxation, meditation and other techniques to help with managing pain, and can help with adjusting to lifestyle changes.
Understanding Peripheral Neuropathy and Cancer
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Expert content reviewers:
Dr Susanna Park, IN FOCUS research program and Senior Lecturer, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, NSW; Katrina Dick, Consumer; Rosemerry Hodgkin, 13 11 20 Consultant, Cancer Council WA; Phil Mendoza-Jones, Consumer; Jodie Nixon, Clinical Team Leader, Occupational Therapy, Cancer Services, Princess Alexandra Hospital, QLD; Rachel Tunney, Consumer; Jane Turner, Senior Exercise Physiologist, Sydney Cancer Survivorship Centre, Concord Hospital, NSW; Dr Shirley Wong, Consultant Medical Oncologist, Sunshine Hospital, Western Health, VIC.
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The information on this webpage was adapted from Understanding Peripheral Neuropathy and Cancer - A guide for people affected by cancer (2020 edition). This webpage was last updated in September 2021.