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Peripheral Neuropathy

Peripheral neuropathy is damage to the nerves outside the brain and spinal cord (peripheral nerves) that carry messages to and from the rest of your body. Depending on where these nerves are damaged, various symptoms may develop:

• Numbness, tingling or pain in the hands and/or feet
• Muscle weakness
• A change in organ function, such as constipation
• Reduced walking speed and balance
• Increased risk of fall and subsequent fear of falling

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Managing Peripheral Neuropathy

Clinical Practice Guidelines

Acupuncture is listed by the Society for Integrative Oncology clinical practice guidelines as an integrative therapy with evidence for usefulness in peripheral neuropathy.²

SIO advises that acetyl-L-carnitine (CAM-Cancer) is not recommended for the prevention of chemotherapy-induced peripheral neuropathy due to potential harm.³

Other Approaches and Evidence

Therapies such as somatic yoga and meditation (SYM) or acupuncture can reduce symptoms and improve function, comfort and the overall quality of life for a person with peripheral neuropathy.

The patient-education resource from the American Society for Clinical Oncology (ASCO) advises an integrative approach to managing peripheral neuropathy:⁴

• Eating well, including a balanced diet that includes specific nutrients such as B vitamins (including B₁ and B₁₂, folic acid) and antioxidants), and that limits alcohol
• Physical therapy
• Massage
• Acupuncture
• Relaxation
• Moving more
• Medications: see the American Society of Clinical Oncology website: Peripheral Neuropathy

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Integrative Programs, Protocols and Medical Systems

• Programs and protocols
• Alschuler & Gazella complementary approaches¹¹
• Block program¹²
• Lemole, Mehta & McKee protocols¹³
• McKinney protocols¹⁴
• Traditional systems
  • Ayurveda
  • Traditional Chinese medicine

Commentary

Laura Pole, RN, OCNS, October 18, 2018: Janie Brown is an oncology nurse and co-founder of a cancer retreat program and centre in Vancouver, British Columbia. Her BCCT story, The Power of the Integrative Approach in Breast Cancer Treatment (see in Personal Stories below), is a treasure trove of helpful information. She describes how her partner with breast cancer and her team made decisions about chemotherapy, wove in useful complementary therapies to prevent and minimize treatment side effects and created a caring community. The integrative plan staved off the usual chemotherapy side effects of peripheral neuropathy, mucositis, fatigue, nausea and neutropenia.

Written by Laura Pole, RN, MSN, OCNS, and Nancy Hepp, MS; most recent update on September 14, 2020.

1. Lapedis M, Adler SR et al. Qualitative analyses from a prospective clinical study of a whole systems Ayurvedic intervention for breast cancer survivorship. Journal of Alternative and Complementary Medicine. 2014 May; 20(5):A75.
2. Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120; Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S; Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232.
3. Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120; Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S; Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232.
4. CancerNet. Peripheral Neuropathy. American Society of Clinical Oncology. May 2017. Viewed March 14, 2018.
5. Cavallo J. Cryotherapy for preventing chemotherapy-induced peripheral neuropathy in patients with breast cancer. ASCO Post. October 12, 2017. Viewed February 14, 2018; Hanai A, Ishiguro H et al. Effects of cryotherapy on objective and subjective symptoms of paclitaxel-induced neuropathy: prospective self-controlled trial. Journal of the National Cancer Institute. 2018 Feb;110(2).
6. Brami C, Bao T, Deng G. Natural products and complementary therapies for chemotherapy-induced peripheral neuropathy: a systematic review. Critical Reviews in Oncology/Hematology. 2016 Feb;98:325-34.
7. Mondal S, Choudhury KB, Sharma Shyam, Gupta Arunima, Dutta S. Comparative study among glutamine, acetyl-L-carnitine, vitamin-E and methylcobalamine for treatment of paclitaxel-induced peripheral neuropathy. Clinical Cancer Investigation Journal. 2014; 3(3):213-219.
8. Van Vu D, Molassiotis A, Ching SSY, Le TT. Effects of qigong on symptom management in cancer patients: a systematic review. Complementary Therapies in Clinical Practice. 2017 Nov;29:111-121.
9. Brami C, Bao T, Deng G. Natural products and complementary therapies for chemotherapy-induced peripheral neuropathy: a systematic review. Critical Reviews in Oncology/Hematology. 2016 Feb;98:325-34; Mondal S, Choudhury KB, Sharma Shyam, Gupta Arunima, Dutta S. Comparative study among glutamine, acetyl-L-carnitine, vitamin-E and methylcobalamine for treatment of paclitaxel-induced peripheral neuropathy. Clinical Cancer Investigation Journal. 2014; 3(3):213-219.
10. Bao T, Zhi I et al. Yoga for chemotherapy-induced peripheral neuropathy and fall risk: a randomized controlled trial. JNCI Cancer Spectrum. 2020 Jun;pkaa048; Galantino ML, Tiger R, Brooks J, Jang S, Wilson K. Impact of somatic yoga and meditation on fall risk, function, and quality of life for chemotherapy-induced peripheral neuropathy syndrome in cancer survivors. Integrative Cancer Therapies. 2019;18:1534735419850627; Galantino ML, Brooks J, Tiger R, Jang S, Wilson K. Effectiveness of somatic yoga and meditation: a pilot study in a multicultural cancer survivor population with chemotherapy-induced peripheral neuropathy. International Journal of Yoga Therapy. 2019;10.17761/2020-D-18-00030.
11. Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer. Berkeley, California: Ten Speed Press. 2013.
12. Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009.
13. Lemole G, Mehta P, McKee D. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.
14. McKinney N. Naturopathic Oncology, 3rd Edition. Victoria, BC, Canada: Liaison Press. 2016.

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More Information

• American Society of Clinical Oncology: Peripheral Neuropathy
• National Cancer Institute: Nerve Problems (Peripheral Neuropathy) and Cancer Treatment
• SIO clinical practice guidelines:
• Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
• Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S.
• Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232.
• Gurdev Parmar and Tina Kaczor: Textbook of Naturopathic Oncology
• Helpsy Inc.: Helpsy Health
• Dawn Lemanne and Victoria Maizes: Advising Women Undergoing Treatment for Breast Cancer
• Integrative Cancer Review
• September 2018 Issue of the Journal of Alternative and Complementary Medicine
• American Society of Clinical Oncology: Cancer.Net
• Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment