Conventional Medical Treatments for Chemotherapy-Induced Peripheral Neuropathy (CIPN)

What is chemotherapy-induced peripheral neuropathy?

Peripheral nerves carry sensation, control movement, and regulate involuntary bodily functions. Chemotherapy-induced peripheral neuropathy (CIPN) occurs when peripheral nerves are damaged following chemotherapy. Symptoms of CIPN usually begin during the first two months of treatment, progress slowly while chemotherapy continues, and stabilize when treatment ends.

Medications

CIPN can cause pain, numbness and tingling when sensory nerves are affected. Medications may be prescribed to manage pain and symptoms from damaged sensory nerves. These may include the following:

• Corticosteroids, such as prednisone, may be prescribed for a short time to treat inflammation.
• NSAIDs, such as ibuprofen or naproxen, can help reduce pain and inflammation.
• Antidepressants, such as amitriptyline, venlafaxine or duloxetine, are effective medications for neuropathic pain.
• Anti-seizure medications, such as gabapentin or pregabalin, may be prescribed to reduce nerve pain.
• Opioids may be prescribed for severe pain.
• Numbing creams or patches, containing lidocaine or capsaicin, can be applied directly on painful areas.
• Lidocaine infusions can help with pain and the effects of allodynia (specifically cold and mechanical).

Additional medications such as beta blockers may be necessary when autonomic nerve damage results in heart rate and blood pressure irregularities. Muscle relaxants may be prescribed to help with spasms from motor nerve damage.

Therapies

A variety of therapies, including biofeedback, acupuncture, relaxation techniques, and physical therapy, can also be used to help manage symptoms of CIPN.

• Biofeedback is a type of therapy that involves the use of technology to monitor involuntary body responses, such as heart rate and perspiration, with the goal of learning to control these responses in order to reduce the symptoms of a mental or physical health condition. Biofeedback therapy may help reduce pain associated with CIPN.
• Acupuncture involves the insertion of needles into various pressure points on the body to stimulate the nervous system. Acupuncture therapy is thought to release endorphins (the natural pain-relieving chemicals in the brain) and stimulate blood flow to damaged nerves.
• Relaxation techniques, including guided imagery, progressive muscle relaxation, and breathing techniques, can help reduce stress and aid with sleep.
• Physical therapy involves the use of several techniques for pain management, including manual massage, endurance training, strength training, and TENS therapy.