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Chemotherapy Induced Peripheral Neuropathy (CIPN)

Between 60% to 90% of patients undergoing chemotherapy will develop peripheral neuropathy.

Peripheral neuropathy is damage to the nerves outside of the brain and spinal cord (your brain and spinal cord are called the central nervous system). These distant nerves are called peripheral nerves. They carry sensations (feeling) to the brain and control the movement of our arms and legs. They also control the bladder and bowel.

Some of the chemotherapy and other drugs used to treat cancer can damage peripheral nerves. When this happens it is called chemotherapy-induced peripheral neuropathy (CIPN). This can be a disabling side effect of cancer treatment

What Are The Symptoms of Chemotherapy Induced Peripheral Neuropathy (CIPN)?

The symptoms of CIPN and their severity depend on which nerves are damaged and how many nerves are affected. Symptoms may develop during or shortly after cancer treatment. Neuropathy may also develop or worsen after your treatment has ended. This occurs most commonly in those who receive platinum drugs and drugs called taxanes. There are 3 types of peripheral nerves that can become damaged.

Sensory nerves: Peripheral neuropathy usually affects your sense of touch and feeling in the hands and feet. Here are the symptoms when the sensory nerves are affected.

  • You may feel like you’re wearing tight gloves or stockings, even though you aren’t
  • You may have an uncomfortable sensation in your hands or feet that may get worse when you touch something
  • Objects on your feet that usually aren’t painful, such as a shoe or bedcovers, may cause pain.
  • You may notice an increased sense of pain, usually described as pinching, sharp stabs, burning, and electrical shocks
  • You may notice that it is difficult to feel hot and cold temperatures or to know if you’ve injured yourself
  • You may have a hard time knowing where your feet and hands are in space. This is called loss of position sense. It may make walking or picking

Motor nerves: Motor nerves send information between your brain and muscles. When these nerves are injured, you may have these symptoms:

  • Trouble walking and moving around
  • Your legs and arms may feel heavy or weak, causing balance and coordination problems
  • It may be difficult to use your hands and arms
  • You may have trouble with everyday tasks, such as texting or buttoning a shirt
  • You may have muscle cramps and notice muscle loss in the hands and feet

Autonomic nerves: These nerves control the body functions you don’t think about to make happen, such as blood pressure and bowel and bladder function. Symptoms include:

  • Inability to sweat normally
  • Gastrointestinal problems, such as diarrhea and constipation
  • Dizziness or light headedness
  • Trouble swallowing
  • Sexual problems

CIPN can cause severe pain and can affect your ability to do things like walk, write, button your shirt, or pick up coins. If it gets very bad, it can cause more serious problems like changes in your heart rate and blood pressure, dangerous falls, trouble breathing, paralysis, or organ failure.

How Does CIPN Start?

Chemo drugs spread through the whole body, and certain types of chemo can damage different nerves. Symptoms tend to start farthest away from the head (toes and feet), but move closer over time. In most cases, people will notice chemo-induced peripheral neuropathy (CIPN) symptoms in the feet, then later on in the hands. For example, symptoms may start in the toes, but move on to the ankles and legs. Likewise, symptoms can move up from the fingers to the hands and arms. CIPN most often affects both sides of the body in the same way. When it affects both hands and both feet, doctors may call it a stocking-glove distribution. CIPN can begin any time after treatment starts. It often gets worse as treatments continues.  With certain chemotherapy drugs, the signs of neuropathy may be delayed by as much as up to one year before they become noticeable.

Which Drugs Are Most Likely To Cause CIPN?

Certain chemo drugs are more often linked to CIPN. These include:

  • Platinum drugs like cisplatin, carboplatin, and oxaliplatin
  • Taxanes including paclitaxel (Taxol® ), docetaxel (Taxotere® ), and cabazitaxel (Jevtana® )
  • Epothilones, such as ixabepilone (Ixempra® )
  • Plant alkaloids, such as vinblastine, vincristine, vinorelbine, and etoposide (VP-16)
  • Thalidomide (Thalomid® ), lenalidomide (Revlimid® ), and pomalidomide (Pomalyst® )
  • Bortezomib (Velcade® ) and carfilzomib (Kyprolis® )
  • Eribulin (Halaven® )

Cancer-Related Risk Factors Leading To Peripheral Neuropathy

Tumor location – A tumor pressing on a peripheral nerve or one that grows into a nerve may damage the nerve.

Radiation therapy –  Radiation therapy may damage nerves. Symptoms may take years to appear.

Surgery – Operations on the lung or breast may lead to neuropathy. Having a leg or arm removed may cause it, too.

Other risk factors that can increase the incidence of CIPN

The following preexisting conditions are known to cause neuropathy. Having any of these may put people with cancer at higher risk for developing neuropathy.

Preventing CIPN From Developing

There have been numerous research articles published in the Journal of Clinical Cancer Research, CNS Drugs journal, and the journal of Current Neuropharmacology that show Acetyl L Carnitine (ALC -an amino acid derivative)  has both neuroprotective (nerve protection and antinociceptive (pain relief) effects. The mechanisms of action of ALC are not clear but clinical trials of several prominent causes of peripheral neuropathy suggest oral doses from 1,000 mg daily to 3,000 mg daily are effective for symptom relief in a majority of patients. Some studies suggest that the regenerative capacity of ALC continues for up to 24 months after beginning therapy. Tolerance to ALC appears to be excellent with mild, infrequent side effects, including insomnia and gastric irritation.

Acetyl L Carnitine (ALC) has also been shown to be effective in nerve repair in cases of peripheral neuropathy caused by:

  • Diabetes
  • HIV Medications
  • Compression induced Peripheral Neuropathy – any physical impingement (pressure) placed on a peripheral nerve resulting in nerve damage.

Given the level of evidence of ALC’s therapeutic effects on various types of Peripheral Neuropathy, combined with its lack of toxicity, ALC has the potential to dramatically affect the quality of life of patients with neuropathy (chemo-induced or otherwise).

Sourced through from:


In 2016, it is estimated that 1,685,210 new cases of cancer will be diagnosed in the U.S., with the vast majority of these patients undergoing chemotherapy.

According to several oncology journals such as, American Academy of Pain Medicine, Journal for Cancer Treatment Review & Seminar of Oncology, 70% to 90% of patients treated with Vincristine and paclitaxel/Taxol will develop CIPN.  These studies further revealed that 60% of people receiving the chemotherapeutic drug, docetaxel/tasotere will develop CIPN and 40% of patients treated with carboplatin will develop CIPN.  These are just a few of the statistics from the chemotherapeutic drugs mentioned in the article.

Unfortunately, if you are undergoing chemotherapy treatment for your cancer, chances are extremely high that you will develop Chemotherapy Induced Peripheral Neuropathy (CIPN).  Having cancer is bad enough without adding this disabling condition to it.

Before you begin your chemotherapy treatment, protect your peripheral nerves with Acetyl L Carnitine.  Dosages of 1,000mg to 3,000mg have been shown to have enormous benefits for protecting peripheral nerves from damage.

Since CIPN, sometimes, will not become evident until after chemotherapy has ended (even up to a year later) it is still in your best interest to safeguard your peripheral nerves with this supplement.

We have known about this research for a number of years and began using it for our patients.  However,  not all Acetyl L Carnitine supplements are created equally.  They don’t all have the same potency or bioavailibility (body’s ability to absorb it).  As a result,  we created our own formulation, called Nervana Blue, which contains 1,000mg of Acetyl L-Carnitine (ALC).  Along with ALC, Nervana Blue also contains L-Arginine and L-Citrulline, shown in research to increase production of nitric oxide, which enhances oxygenation to the nerves and circulation.  We, also, incorporated vitamin E into the formula for increased nerve protection and to minimize free radical damage (a common and extensive result of chemotherapy drugs).

We have had phenomenal results with not only preventing CIPN but also with repairing the damage of CIPN.  Our results were so astounding that we were contacted by one of the very large cancer treatment centers here in San Antonio.  Several of their Chemotherapy patients had been talking about our clinic, The San Antonio Neuropathy Center, and the results they had with reversing their CIPN.  The oncologists were quite intrigued and invited us over for a meeting to find out what we were doing.  We were more than happy to share our information with them for the benefit of the neuropathy patients.

Don’t wait until you develop CIPN.  Protect yourself immediately.  If you have already developed CIPN, Nuphoria can still help to repair the damage of the peripheral nerves.

To learn more-visit:
Dr. John Coppola, D.C. and Dr. Valerie Monteiro, D.C.

This blog has been provided by Dr. John Coppola, D.C. and Dr. Valerie Monteiro, D.C. Dr. Coppola and Dr. Monteiro are the founders of the San Antonio Neuropathy Center, and Precision Sport & Spine. They are the leading experts in the field of neuropathy and specifically drug free nerve repair. They are the authors of the critically acclaimed book “Defeat Neuropathy Now …. In Spite of Your Doctor. The doctors have over 25 years of clinical experience.

If you would like to reach the doctors regarding a specific health problem, you may email them at [email protected].

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