Peripheral Neuropathy

---

Peripheral neuropathy refers to inflammation, injury or degeneration of the nerve cells. This may result from underlying conditions such as cancer, diabetes, infection, nutritional disorders, kidney disease and hypothyroidism. In cancer patients, peripheral neuropathy may occur due to the location of tumors or due to side effects of chemotherapy. Vincristine, Velban, cisplatin, Taxol, VP-16 and Navelbine are some of the drugs most commonly implicated.

Symptoms of peripheral neuropathy frequently include numbness and/or tingling in the hands and feet; loss of fine motor control; loss of sensation to temperature or vibration; unusual sensations such as electric or burning pain; abnormal gait; and loss of strength or weakened muscles. Any of these symptoms should be reported to your physician.

The nerves that control bowel and bladder function (the autonomic nervous system) may also be affected, resulting in constipation or difficulty urinating. Constipation should be treated with stool softeners and/or laxatives, as well as by increasing fiber and fluid intake. If you experience any difficulty urinating, your physician should be notified.

When sensation is altered, it becomes very important to evaluate your environment for safety. We would like to offer the following suggestions:

In the home

• Use care when cooking. Use potholders to handle pans and to remove pots from the oven. Avoid excessively hot water for dishwashing and wear rubber gloves. Be extra careful when using knives or handling glass that could be slippery. Use visual cues to increase safety when tactile sensation is decreased.

• Assistive devices are available to compensate for decreased muscle strength. These include zipper pulls, knob turners, writing grips, jar openers, easy lamp switches, long shoe horns, Velcro straps, and weighted utensils. Some of these are available from hardware stores; others can be obtained through an occupational therapist.

• Reduce the risk of injury in the bathroom. Install handrails in the shower or tub, or near the toilet. Use soap on a rope and safety bars in the tub or shower. Wet floors can be dangerous; outside the tub, bathmats with rubber backing are safer than those without. Bathtub thermometers are available to avoid scalding when sensation is decreased.

• Electric shavers are safer than razors.

• Wear gloves and socks when the temperature drops. Slippers should be worn, and should have rubber soles. If you have area rugs, make sure they have nonskid backing or are affixed to the floor to minimize the risk of tripping.

Around the home

• Clean up oil and other spills in the garage promptly.

• Keep hoses and tools off the floor where they could be tripped over. Hang up rakes and brooms.

• Wear gloves in the garden to avoid scratches and to keep dirt out of cuts. Use care when cutting anything in the yard.

• It is important to evaluate your ability to do certain tasks safely, especially when using any motorized equipment. Seek assistance for especially risky tasks such as mowing the lawn, climbing ladders, and carrying heavy objects. You should discuss the safety of driving a car with your physician if you have experienced a change in sensation or reflexes in your legs or feet.

Treatment Approaches

Medications are available that can reduce the discomfort of peripheral neuropathy. These include oral narcotics to relieve pain, as well as anticonvulsants and antidepressants, which act on nerve cells to relieve pain and other symptoms. Your physician will discuss the potential benefits of using these medicines with you.

Non-pharmacologic approaches include physical therapy for range of motion exercises, stretching, and massage.

Occupational therapists may be able to assist with orthotic devices, splints or canes.

Coping with peripheral neuropathy can be challenging. Often symptoms may be transient, though recovery may take a long time to achieve. In some cases, symptoms may be permanent. For these reasons, it is important step up an ongoing dialogue with your caregivers both at the doctor's office and at home to minimize the risk of injury and maximize comfort.