Cancer is a harsh illness no matter where it strikes in the body. When cancer treatments also lead to health issues, the situation may seem overwhelming.
Today, we’re taking a look at the problem of neuropathic pain in people who have cancer. When nerves are injured by tumors, surgery, or by certain types of cancer treatments, they normally send pain signals to the brain. These signals are almost like warning flares at an accident; they let the brain know that something is wrong. In people with neuropathic pain, though, these warning fires keep blazing, long after they should have burned out.
The injured nerves in people with neuropathic pain act the same way: Instead of calming down once time has passed after an injury, these nerves may stay “on fire,” sending confusing (or wrong) pain messages to the brain instead.
What types of symptoms can result?
- Stabbing, burning, or “electric shock” pains
- Tingling or “pins and needles” sensations
- Numbness or loss of feeling in some areas
- Severe pain due to non-painful/slightly-painful reasons, such as a pinprick
- Problems with balance or walking
- Muscle weakness, or “heaviness” in an arm or leg
A common type of neuropathic pain in people with cancer is peripheral neuropathy. Peripheral neuropathy is caused by signals that come from nerves in the peripheral nervous system – the part of the nervous system that sends messages between the brain, the internal organs, and the limbs. Hands and feet are usually the areas affected, causing some of the symptoms listed above. Other areas that are closer to the center of the body may have problems later on.
Some of the medications used for chemotherapy treatment (such as cisplatin, ifosfamide, paclitaxel, and vincristine) are listed among the top causes of peripheral neuropathy in cancer patients.
How do I decide?
People with cancer usually help to choose their treatments. These decisions are based on the risks of each treatment versus the benefits. The risks are the side effects of each medication, and the benefits include getting rid of the cancer. It can be scary to make these decisions, and hard to know which option is best. Here are some suggestions:
- Your cancer team will help by sharing important facts about each treatment option.
- You could ask how many people usually get neuropathic pain with each type of treatment that’s suggested.
- You could ask how likely it is to recover from neuropathic pain after treatment is stopped. Do some people keep getting worse?
- If you already had peripheral neuropathy before getting cancer, ask which treatments don’t cause neuropathic pain.
- If you’ve had chemotherapy in the past that caused neuropathic pain, you may have a higher chance of developing it again.
- Chemotherapy is sometimes given with a “cocktail” approach, where more than one medication is used at a time. There is sometimes a higher risk of peripheral neuropathy with “cocktail” treatments.
Be on the lookout for neuropathic pain
Neuropathic pain can be disabling. Help guard against it by telling your cancer team right away about neuropathic pain symptoms, or about any strange feelings that you have during (or after) treatments. Based on what they hear, they’ll decide whether your chemotherapy dose needs to be lowered, or if the treatment needs to be changed. Sometimes, coming down with severe neuropathic pain can be enough to stop treatment.
Your cancer team may also do special tests of your nerves before you start treatment, before each treatment, and after your treatments are done. They want you to be safe: That’s because once neuropathic pain begins, it may not go away. In some cases, it may get worse even after you stop the treatments.
Researchers are now trying to find ways to prevent chemotherapy-caused neuropathy before it even starts, by treating cancer patients with protective drugs like glutamine and glutathione.
Treatments for neuropathic pain
If you get neuropathic pain during cancer treatment, your cancer team may try to treat it instead of changing your care plan:
- Anti-seizure drugs (like gabapentin) and antidepressants (like amitriptyline or paroxetine) are often the first options for treating neuropathic pain.
- Narcotic medications (like morphine or hydromorphone) may help to relieve peripheral neuropathy, although their doses may need to be high, and their helpfulness may be limited.
Learn more about neuropathic pain at the resources listed below.
The Neuropathy Association
http://www.neuropathy.org (search on “neuropathic pain”)
National Cancer Institute
http://www.cancer.gov (search on “pain control” or “neuropathic pain”)
American Cancer Society
http://www.cancer.org (search on “neuropathic pain”)
American Chronic Pain Association
http://www.theacpa.org (search on “neuropathic pain”)