Peripheral Neuropathy Caused By Chemotherapy

By Dr. John Coppola, DC and Dr. Valerie Monteiro, DC

Cancer is the second leading cause of death in the U.S., leading to more people (than ever before) receiving chemotherapy treatment. It has become a well-established fact that 90% of all chemotherapeutic drugs cause peripheral neuropathy.

Chemotherapy Induced Peripheral Neuropathy (CIPN)

Chemotherapy Induced Peripheral Neuropathy (CIPN) is a result of peripheral nerve damage from chemotherapy (chemo) treatment. Peripheral nerves are a group of nerves that run off the spinal cord and travel to the legs and feet and arms and hands. When these nerves become damaged as a result of chemotherapy, it is refered to as CIPN (chemotherapy induced peripheral neuropathy).

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, but move closer over time. In most cases, people will notice chemo-induced peripheral neuropathy (CIPN) symptoms in the toes and feet. Later the symptoms will move on to the ankles and legs. As time progresses, symptoms can also begin to develop in the fingers and then move into 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, it is referred to by doctors as a stocking-glove distribution.
CIPN can begin with the first treatment or may take several weeks, depending on the chemo drug being used. Symptoms often get worse as treatments continues.

Symptoms of CIPN

The symptoms of chemo-induced peripheral neuropathy (CIPN) depend mostly on which nerves are involved. Most commonly a combination of motor (M) and sensory (S) nerves can be affected. Autonomic (A) nerves that control the organ systems and their functions can also be affected in severe cases.

The most common symptoms are:

• Sharp, Shooting or Stabbing Pain (S)
• Dull Achy Pain (S)
• Burning (S)
• Tingling (“pins and needles” feeling) or electric/shock-like pain (S)
• Numbness (S)
• Loss of feeling or sensations (S)(M)
• Trouble using your fingers to pick up or hold things; dropping things (M)(S)
• Weakness in the legs (M)
• Balance problems (M)(S)
• Weakness in hands or arms (M)
• Trouble with tripping or stumbling while walking (M)(S)
• Being more sensitive to cold or heat (S)
• Being more sensitive to touch or pressure (M)(S)
• Muscle atrophy (shrinking) (M)
• Muscle weakness (M)
• Trouble swallowing (M)(A)
• Constipation (A)
• Trouble passing urine (M)(A)
• Blood pressure changes (A)
• Decreased or absent reflexes (M)

The symptoms from CIPN seldom go away on their own. Typically, they will tend to worsen over time. Your symptoms may start out with a minor case of numbness in your feet, but later can progress to severe pain in the feet and legs. The pain can become so debilitating that it can affect your ability to walk, write, or even, button your shirt.

Many patients afflicted with CIPN will develop balance problems and instability leading to dangerous falls.

Chemo Drugs 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®)

CIPN Protection

Chemotherapy treatment, alone, is bad enough without worrying about developing CIPN. There are safe and effective things you can do to protect your nerves from damage, while receiving chemotherapy treatment.
Current research has now revealed that a naturally occurring amino acid derivative, Acetyl L -Carnitine (ALC) has both neuroprotective and antinociceptive effects. In a nutshell, this means, it has the ability to protect the peripheral nerves from damage caused by chemotherapy, and if damage has already occurred, it can decrease the pain associated with the nerve damage. What scientists are even more pleased with is the fact that, taking ALC while receiving chemo will not alter your results or interfere with your chemo treatments.

Since not all supplements are created equally, it is important to get a high quality Acetyl L-Carnitine. Make sure that your Acetyl L-carnitine is cGMP certified and is manufactured by a lab that is registered with the FDA. This is not the same as being FDA approved. The FDA does not have an approval process or rating for supplements. However, if a lab is registered with the FDA, this means that the FDA will conduct audits of the facility and verify that they are maintaining the quantity and quality of raw material as reported on table. Recommended dosages of ALC are 1000 mg daily to 3000 mg daily. Studies have shown that these dosages provide the most protection to the nerves and assist in nerve regeneration (growth)

Other Benefits of Acetyl L-Carnitine (ALC)

Studies have concluded that ALC also provides protection to the peripheral nerves from damage typically caused by elevated glucose levels. This would include elevated levels due to pre-diabetes and diabetes. More than 60% of all diabetics will develop peripheral neuropathy. New evidence suggests that even pre-diabetics (fasting flood sugar levels from 100 – 124 mg/dL) are at an elevated risk for developing peripheral neuropathy. Clinical studies have shown that Acetyl L-carnitine protects the peripheral nerves from damage caused by the chronically elevated glucose levels.

Furthermore, ALC has also been shown to repair damage to nerves resulting in Compression-Induced Neuropathy and even Sciatica.

Multiple studies published in well respected journals, such as, Diabetes Care and Current Neuropharmacology all conclude that taking Acetyl L-Carnitine can reduce pain associated with peripheral neuropathy, while stimulating nerve regeneration (growth) and returning vibratory perception (decreasing numbness).

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].

References

Abramowski MC. Chemotherapy-induced neuropathic pain. J Adv Practit Oncol. 2010;1:279-283.
Biedrzycki BA. Peripheral Neuropathy. In Brown CG (Ed) A Guide to Oncology Symptom Management. 2010; Oncology Nursing Society, Pittsburgh: 405-421.

Coyle N, Silver J, Meuche G, Messner C. Understanding Peripheral Neuropathy. CancerCare booklet edited and produced by Elsevier Oncology. 2008.

Gamelin L, et al. Prevention of oxaliplatin-related neurotoxicity by calcium and magnesium infusions: A retrospective study of 161 patients receiving oxaliplatin combined with 5-fluorouracil and leucovorin for advanced colorectal cancer. Clin Cancer Res. 2004;10:4055-4061.

Kaley TJ, DeAngelis LM. Therapy of chemotherapy-induced peripheral neuropathy. Br J Haematol. 2009;145:3-14.
Loprinzi CL, Qin R, Dakhil SR, et al. Phase III randomized, placebo-controlled, double-blind study of intravenous calcium and magnesium to prevent oxaliplatin-induced sensory neurotoxicity (N08CB/Alliance). J Clin Oncol. 2014;32:997-1005.

National Cancer Center Network, NCCN Clinical Practice Guidelines in Oncology™. Adult Cancer Pain, v. 1.2015. Accessed at www.nccn.org/professionals/physician_gls/pdf/pain.pdf on March 17, 2015.

Paice JA. Clinical challenges: Chemotherapy-induced peripheral neuropathy. Semin Oncol Nurs. 2009;25(2 Suppl 1):S8-S19.

Piccolo J, Kolesar JM. Prevention and treatment of chemotherapy-induced peripheral neuropathy. Am J Health Syst Pharm. 2014;71:19-25.

Richardson PG, Xie W, Mitsiades C, Chanan-Khan AA, et al. Single-agent bortezomib in previously untreated multiple myeloma: Efficacy, characterization of peripheral neuropathy, and molecular correlations with response and neuropathy. J Clin Oncol. 2009;27:3518-3525.

Stubblefield MD, McNeely ML, Alfano CM, Mayer DK. A prospective surveillance model for physical rehabilitation of women with breast cancer: Chemotherapy-induced peripheral neuropathy. Cancer. 2012;118(8 Suppl):2250-2260.
Tournigand C. OPTIMOX1: A randomized study of FOLFOX4 or FOLFOX7 in a stop-and-go fashion in advanced colorectal cancer–A GERCOR study. J Clin Oncol. 2006;24:394-400.

Visovsky C, Collins M, Abbott L, Aschenbrenner J, Hart C. Putting evidence into practice: Evidence-based interventions for chemotherapy-induced peripheral neuropathy. Clin J Oncol Nurs. 2007;11:901-913.
Wickham R. Chemotherapy-induced peripheral neuropathy: A review and implications for oncology nursing practice. Clin J Oncol Nurs. 2007;11:361-376.

Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet. 1999;353(9168):1959-1964.

Shy M, ed Peripheral Neuropathies. 23rd ed. Philadelphia, Pa: Saunders, Elsevier; 2007. D GLA, ed. Cecil Medicine.

Chiechio S, Copani A, Nicoletti F, Gereau RWt. L-acetylcarnitine: a proposed therapeutic agent for painful peripheral neuropathies. Curr Neuropharmacol. 2006;4(3):233-237.

Vanotti A, Osio M, Mailland E, Nascimbene C, Capiluppi E, Mariani C. Overview on pathophysiology and newer approaches to treatment of peripheral neuropathies. CNS Drugs. 2007;21 Suppl 1:3-12; discussion 45-16.

Mold JW, Vesely SK, Keyl BA, Schenk JB, Roberts M. The Prevalence, Predictors, and Consequences of Peripheral Sensory Neuropathy in Older Patients. J Am Board Fam Pract. 2004;17(5):309-318.

ND J, Dementia A, Effects C. Acetyl-L-carnitine: metabolism and applications in clinical practice. Alternative Medicine Review. 1996;1(2):85.