Peripheral neuropathy happens when nerves, most commonly in the fingers and toes, are damaged. Damage to these nerves can be caused by breast cancer or, more commonly, its treatment.
Peripheral nerves send messages to and from the brain and the spinal cord (the central nervous system) and the rest of the body.
The nerves in the hands and feet are long nerves and are more prone to damage.
Causes of peripheral neuropathy
The most common cause of peripheral neuropathy in people with breast cancer is chemotherapy.
The most common drugs that may cause peripheral neuropathy are:
These drugs can cause damage to the nerves that allow you to feel sensations like pain, temperature, touch and vibration (called sensory nerves) but other nerves can be affected too.
Peripheral neuropathy can also be caused by the cancer pressing on a nerve or other cancer treatments, such as surgery or radiotherapy.
Whether you experience peripheral neuropathy will depend on:
- the drug or combination of drugs you are having
- the dose you are prescribed
- whether you have had previous treatment for cancer that causes peripheral neuropathy
- whether you are diabetic
Symptoms of peripheral neuropathy
Symptoms of peripheral neuropathy can include:
- pain (often burning or shooting)
- pins and needles or tingling
- a feeling of warmth or cold
- increased sensitivity
- difficulty doing ‘fiddly’ tasks such as fastening buttons
For some people the symptoms are mild and go away soon after treatment stops. However, for most the symptoms will last longer, gradually improving over the weeks and months after the treatment has finished. Some symptoms may not disappear completely and, occasionally, the symptoms can worsen even after the treatment has stopped.
Reducing the risk
There’s no sure way to prevent or reverse peripheral neuropathy, though studies are looking into this.
If you have already had peripheral neuropathy and need further treatment for your cancer, your doctor may discuss using drugs that do not have this as a possible side effect.
Treating peripheral neuropathy
If you develop any symptoms let your specialist team know. For most people symptoms are likely to slowly and gradually improve over time once the drug is stopped. However, in some cases peripheral neuropathy is permanent.
If the symptoms you are experiencing are having a big impact on your quality of life, your doctor may talk to you about delaying, reducing or stopping treatment to make sure it doesn’t get any worse.
Treatment is mostly given to relieve nerve pain (sometimes called neuropathic pain). This can be helped by taking drugs usually used to help treat depression or epilepsy, which are known to also help pain caused by damage to nerves. These include amitriptyline, pregabalin and gabapentin. Unlike many other types of pain, nerve pain isn’t helped much by common pain relief drugs such as paracetamol and ibuprofen.
Your cancer specialist can also refer you to a specialist pain team who may suggest other types of pain relief or alternative ways of trying to manage symptoms, for example using physiotherapy or acupuncture.
If you’re experiencing numbness in your hands and feet, try to limit the possibility of injury. For example, don’t walk barefoot and protect your hands and feet from getting too hot or cold.
It’s also important to check regularly for any injuries to your hands and feet so that if you do injure yourself, this can be dealt with quickly. This may prevent the injury getting worse or you developing an infection.
A referral to an occupational therapist may be useful for people with persistent problems. They may have ideas for ways of helping with everyday activities.
If you are struggling with the side effects of breast cancer treatment you don’t have to cope alone. You can call our Helpline free on 0808 800 6000 for information and support. We can also put you in touch with one of our trained volunteers, who have personal experience of breast cancer and know what you are going through.