Eight Ways to Prevent Chemotherapy Induced Neuropathy

What is neuropathy?

Certain chemotherapy drugs and other cancer related treatments can cause peripheral neuropathy, a set of symptoms caused by damage to nerves that control the sensations and movements of our arms, legs, hands, and feet. Neuropathy affects 30%-40% of patients undergoing chemotherapy. Neuropathy can cause numbness, tingling, or pain in your extremities and unfortunately, it can have a negative impact on your quality of life. 

Peripheral neuropathy can also result from diabetes as well as vitamin deficiencies but in this case we're going to talk about neuropathy as a result of chemotherapy drugs.  The most common chemotherapy drugs that cause neuropathy are the platinum drugs (carboplatin, cisplatin, oxaliplatin), the Vinca alkaloids (navelbine, vincristine) and the taxanes (docetaxel and paclitaxel).

Eight Ways to Prevent Chemo Induced Neuropathy

1. Icing (cryotherapy) during the administration of a taxane drug has been shown to either prevent neuropathy altogether or lessen the degree of neuropathy that one can develop. A meta analysis published in 2021 showed the significance of icing. PMID: 34912720. I was always taught to avoid cold exposure with oxaliplatin as it has a cold induced sensitivity. Colontown, a group for those with colorectal cancers have provided some successful data on patients using ice during the administration of oxaliplatin. It can actually reduce the cold induced sensitivity and lessen the degree of CIPN. There are no published studies yet on cryotherapy with oxaliplatin. I have a few current clients who used icing during oxaliplatin and have noted success with minimal neuropathy. 90% of patients who receive oxaliplatin report symptoms of neuropathy. You can purchase ice booties and mitts to use during chemotherapy administration on amazon or bring ice packs to the cancer center. 
2.  Glutamine is a nonessential amino acid that is thought to have a neuroprotective role, possibly due to the upregulation of nerve growth factor. Glutamine can also help with gut health and inflammation. Studies show using glutamine powder 20 to 30 grams in divided doses daily can help with neuropathy prevention. You can mix it in coffee, water, or a smoothie. 
3. Alpha lipoic acid (ALA) is a physiologic antioxidant that has been examined quite extensively as a treatment for diabetic neuropathy, but not fully explored in CIPN. ALA has been shown to be effective in the treatment of distal sensory motor neuropathy as well as in the modulation of peripheral neuropathy and pain reduction in diabetic patients. PMID: 24362907.  Recommended dosing is 300 mg once daily in the morning. Can increase to 300 mg twice daily or 600 mg daily in the morning if neuropathy symptoms progress.  
4. B vitamins are a group of 8 water-soluble vitamins. The body does not store them, so they need to be replaced daily. B vitamins are found in animal proteins, dairy products, leafy green vegetables, and beans. They are critical cofactors for axonal transport, synthesis of neurotransmitters, and many cellular metabolic pathways. They have been found to play an important role in CIPN prevention, but more studies need to be done. My recommendation is a methylated B complex daily. 
5. Acupuncture therapy has a long history of treating pain syndromes. It is safe and effective in treating CIPN. General recommendation is to receive acupuncture weekly to manage symptoms. 
6. CBD is protective against PAC-induced neurotoxicity mediated in part by the 5-HT1A receptor system. Studies have shown CBD may be enhanced by low doses of THC to help with CIPN prevention. 
7. Physical therapy can help improve balance impacted by CIPN and regain strength after chemotherapy. 
8. Seek help from your supportive care oncology team or palliative care medicine team at your local cancer center for more advice on CIPN management. 

Prescription medications to Reduce neuropathic pain

1. Gabapentin (neurontin): An Anticonvulsant, mostly widely used for nerve pain. The most common side effect I have seen with this drug is grogginess, drowsiness, and dizziness. I usually advise initiating this drug at night and starting at a low dose of 100-300 mg at bedtime. This drug can be titrated nicely and has a maximum dosage of 4800 mg per day.
2. Duloxetine (Cymbalta): An antidepressant that has been shown to inhibit central pain. Dosing is 30-60 mg per day. I recommend starting with 30 mg and titrating to 60 if no improvement after several days. 
3. Amitriptyline and Nortriptyline: Tricyclic antidepressants that are also used to treat migraines and neuropathic pain. Dosing is recommended at night and starts as low as 10 mg daily.