Key points
- Chemotherapy-induced peripheral neuropathy is damage to the peripheral nerves and usually shows up as numbness, tingling, pins and needles or pain in the hands and feet [1].
- It affects 3 to 4 in every 10 patients having chemotherapy that can damage nerves [6]; platinum drugs, taxanes and vinca alkaloids are among the commonest causes [7].
- Symptoms often ease with time: in the first month after chemotherapy more than half of patients have them, but after 6 months about one in 3 [5].
- No medicine is recommended for prevention; if neuropathy becomes intolerable, your doctor may lower the dose, delay or change the treatment [2].
- Duloxetine is the only medicine with enough evidence for treating established painful neuropathy, although its effect is limited [2].
- Report symptoms early; early recognition and management is the best way to prevent further damage [1].
Why and how does neuropathy happen?
Peripheral nerves carry messages between the brain and spinal cord and the rest of the body. Some anticancer drugs damage these nerves, and the symptoms depend on the type of nerve affected [1]:
- Sensory nerves: tingling, numbness or pins and needles in the feet and hands that may spread up to the legs and arms; not feeling heat, cold or pain (for example a cut on the foot).
- Motor nerves: muscle weakness or pain, loss of balance, falls, difficulty doing up buttons or opening jars, muscle cramps.
- Autonomic nerves: constipation or diarrhoea, dizziness from low blood pressure, sexual problems, sweating too little or too much, and bladder problems.
This side effect is mostly sensory and painful and can cause long-term problems in survivors [6]. Platinum drugs (such as oxaliplatin and cisplatin), taxanes (such as paclitaxel and docetaxel) and vinca alkaloids (such as vincristine) are the main causes [6, 7]; some multiple myeloma drugs such as bortezomib and thalidomide can also cause neuropathy [6]. Pre-existing neuropathy, smoking and reduced kidney function are reported risk factors [5].
As well as cumulative neuropathy, oxaliplatin can cause acute cold-related symptoms in the hours and days after the infusion, such as tingling in the hands and mouth or throat discomfort on contact with cold [6]. On these days avoid cold drinks and foods and direct contact with cold objects, and wear gloves.
What helps?
Safety and daily care
Preventing falls
Clear rugs and obstacles out of the way, fit grab rails in the bathroom and hallways, use a non-slip mat in the bathroom, wear sturdy shoes with soft soles, and get up slowly after sitting or lying down [1].
Kitchen and bathroom
Use oven gloves for hot dishes, take care with knives and sharp objects, and ask someone to check the water temperature so you do not get burned [1].
Protect your hands and feet
Wear shoes at home and outside, check your hands, legs and feet every day for cuts or scratches, and keep your hands and feet warm in cold weather [1].
Get help and take your time
Ask for help with difficult tasks and allow more time to get things done [1].
Exercise
In a careful study of 355 patients having chemotherapy, a 6-week home programme of walking and resistance exercise slightly reduced hot and cold symptoms in the hands and feet [7]. Work out a safe plan with your doctor or physiotherapist.
Complementary therapies
Physiotherapy, acupuncture, massage or yoga are sometimes suggested to ease pain; talk to your care team before starting [1].
What can your doctor do?
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- Adjusting treatment: with intolerable neuropathy or loss of function, your doctor will consider delaying, lowering the dose of, replacing or stopping the drug responsible [2]. That is why reporting symptoms early matters.
- Duloxetine for nerve pain: in one study, duloxetine reduced nerve pain in more patients than a dummy pill [4].
- Cold during taxane infusions: in a small study, wearing frozen gloves and socks during weekly paclitaxel infusions reduced neuropathy symptoms in the treated limb [8]; this method is not yet standard in every centre.
- Referral to physiotherapy, occupational therapy or a pain specialist if needed [1].
For physicians
Guideline summary for physicians
- ASCO 2020: the data reaffirmed that no agent is recommended to prevent CIPN, and acetyl-L-carnitine for prevention should be discouraged. With intolerable neuropathy or functional impairment, consider delaying, reducing, substituting or stopping chemotherapy. Duloxetine is the only agent with adequate evidence for established painful CIPN, but its benefit is limited [2]. In this update, the evidence on cryotherapy, compression and exercise for prevention was judged insufficient for a recommendation [2].
- ESMO–EONS–EANO 2020: guideline on the diagnosis, prevention, treatment and follow-up of peripheral and central neurotoxicity of anticancer treatments [3].
- Duloxetine trial (CALGB 170601): 231 patients with pain ≥4 out of 10 after paclitaxel, other taxanes or oxaliplatin; duloxetine for 5 weeks (30 mg in week 1 then 60 mg daily) versus placebo; mean pain reduction 1.06 versus 0.34 (P=0.003; effect size 0.513) [4].
- Epidemiology: meta-analysis of 31 studies (4179 patients): prevalence 68.1% in the first month, 60.0% at 3 months and 30.0% after 6 months; clinical risk factors included baseline neuropathy, smoking, abnormal creatinine clearance and specific sensory changes during treatment [5].
- Cryotherapy: in the Hanai study (36 evaluable patients, weekly paclitaxel 80 mg/m²), reduced tactile sensitivity of the hand was 27.8% on the treated side versus 80.6% on the control side [8].
Myths and facts
| Common belief | Fact |
|---|---|
| If I tell my doctor, my treatment will be stopped; better to put up with it. | Reporting early allows the dose to be adjusted in time and prevents permanent damage [1, 2]. |
| Vitamins and supplements prevent neuropathy. | No agent is recommended for prevention, and the ASCO guideline discourages acetyl-L-carnitine for prevention [2]. |
| Ordinary painkillers get rid of nerve pain. | Nerve pain responds differently; duloxetine is the only medicine with enough evidence [2]. |
When should I call my doctor?
- New or worsening numbness, tingling or pain in the hands and feet, especially before your next chemotherapy cycle [1, 2].
- Muscle weakness, falls, loss of balance or difficulty walking, doing up buttons or writing [1].
- Difficulty swallowing or breathing; go to the emergency department straight away [1].
- Dizziness or feeling faint when you stand up, severe constipation or difficulty passing urine [1].
- A cut, sore or burn on your foot that you had not noticed, or that has signs of infection (redness, swelling, a temperature of 38 °C or higher) [1, 9].
Frequently asked questions
When does neuropathy start and how long does it last?
Is it safe for me to drive?
If you have less feeling in your feet or have trouble telling the pedals apart or gripping the steering wheel, talk to your doctor. Weakness and loss of feeling can put your safety at risk [1].
Duloxetine is an antidepressant; why has it been prescribed for me?
Related cancer types
Related guides
References
9 referencesShow all references, 6 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2
- 3Systemic anticancer therapy-induced peripheral and central neurotoxicity: ESMO–EONS–EANO Clinical Practice Guidelines for diagnosis, prevention, treatment and follow-up
- 4
- 5
- 6
- 7
- 8Effects of Cryotherapy on Objective and Subjective Symptoms of Paclitaxel-Induced Neuropathy: Prospective Self-Controlled Trial
- 9Infection and Neutropenia during Cancer Treatment
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
Printed from the website; the full and up-to-date version: https://drdabiri.com/en/guides/peripheral-neuropathy/