From tingling in hands and feet to pain and gait disorders. Polyneuropathy involves a wide range of symptoms.
But what exactly does “chemotherapy-induced polyneuropathy” (CIPN) mean?

Basically, polyneuropathy is a group of disorders in which the peripheral nervous system does not function properly. So there are parts of the nervous system located outside the brain and spine. Chemotherapy-induced polyneuropathy limits symptoms to symptoms that are triggered (induced) by chemotherapy.

Depending on which substance is used in chemotherapy, the onset of CIPN symptoms varies between 19-95% during or immediately after treatment. Around a third of patients describe symptoms of chronic CIPN even six months after completing chemotherapy.

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What are the symptoms of CIPN?

Symptoms of chemotherapy-induced polyneuropathy are usually symmetrical, both on the left and on the right hands and feet. A distinction is made between sensory and motor symptoms.

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Sensory symptoms

The sensory symptoms in particular are very diverse. Patients often describe

• hypersensitivity
• Discomfort such as tingling or “ant walking”
• soreness
• numbness
• Temperature and vibration perception disorders

in hands and feet.

Although these symptoms are not life-threatening, they are considered unpleasant and annoying. However, some sensory disorders pose risks: Numbness can cause fine motor problems in everyday life. This can lead to difficulties in writing, loss of balance and falls. In addition, the numbness often causes superficial injuries to go unnoticed, increasing the risk of wound infection.

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Motor symptoms

Motor symptoms occur much less frequently. They are manifested by weakened muscle reflexes, reduced muscle strength with possible limitation in walking and standing ability, involuntary muscle twitching and muscle cramps.
Vision problems or hearing and balance disorders can also occur due to functional limitations of the cranial nerves

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Risk factors of chemotherapy-induced polyneuropathy

The likelihood of developing CIPN symptoms was increased in patients receiving platinum derivatives, taxanes, vinca alkaloids, eribulin, bortezomib, or thalidomide as chemotherapy agents.
In addition, CIPN also benefits from the following factors:

• Diabetes mellitus
• renal insufficiency
• HIV infection
• hypothyroidism
• genetic factors (CMT gene mutation)
• specific rheumatic and autoimmune diseases (collagenosis/vasculitis)
• high alcohol consumption
• vitamin deficiencies
• older than 75 years

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Chemotherapy-induced polyneuropathy: prevention and treatment options

If chemotherapy is necessary, preventive measures can help to reduce side effects such as polyneuropathy.

For example, it is currently recommended that regular functional training be carried out at the start of therapy. Functional training includes various physical activities such as endurance, weight training, balance training and yoga. Medicinal prophylaxis is currently not recommended.

Pay particular attention to your body during therapy. If the first symptoms occur, discuss them with your doctor. Depending on the symptoms, their occurrence, frequency and severity, a reevaluation of chemotherapy may be appropriate: Treators usually weigh the benefits and risks of certain types of therapy, review the dosage, and frequency of chemotherapy. Other therapeutic measures, i.e. switching therapy to another medication, can also be considered.

Currently, no drug has been approved for the drug treatment of chemotherapy-induced polyneuropathy. However, experts make a moderate recommendation for the drug in the guidelines duloxetine off, which can alleviate the pain. Antidepressants and anticonvolutives or antiepileptics (e.g. amitriptyline, venlafaxine, gabapentin, pregabalin) may also be considered. Anti-epileptics are effective against muscle cramps, among other things. Opioids and also specific patches and ointments for pain may also be considered.

Sports and physiotherapy are recommended for the treatment of chemotherapy-induced polyneuropathy, similar to prevention. Occupational and electrotherapy can also reduce symptoms. Actions often target the following areas:

• sensorimotor training
• coordination training
• vibration training
• fine motor training
• endurance training
• Walking and standing training
• Tai Chi

These therapies can promote dexterity, balance, and mobility. The risk of falls is reduced. There are also other side effects such as reduced weight.

In addition, small adjustments can make everyday life easier. Sturdy shoes or a walker can provide a good footing. Conscious hand and foot care also protects against injuries and infections.

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synopsis

Chemotherapy-induced polyneuropathy is a disease characterized by abnormalities, pain and functional complaints in everyday life. It is triggered by the nerve-damaging side effects of tumour therapy and can extend beyond the duration of treatment, but is usually declining. Therapeutically, it is possible to relieve pain and cramps with medication. An improvement in function is achieved through occupational and electrotherapy, but also guided movement therapy, which is recommended even before symptoms begin with the start of cancer treatment. This multimodal therapy can improve the quality of life for the period of illness.

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