Numbness and Tingling


What is numbness and tingling (Peripheral Neuropathy)?

Numbness and tingling is swelling or damage to the nerve fibers. It is associated with some cancer treatments, such as chemotherapy or radiation. In some people, the cancer itself may contribute to numbness and tingling if it is compressing nerve endings. Numbness and tingling is a sensation that generally occurs in the hands and feet. It can interfere with walking, driving, ability to sense temperature differences, and other normal daily activities. People experience numbness and tingling differently. Symptom specifics, such as how severe it is or how long it lasts, will vary from person to person.

It is very important that all symptoms are reported to your healthcare provider immediately. Early reporting of numbness and tingling is the best way to decrease the severity and prevent further complications.


How do people describe numbness and tingling (Peripheral Neuropathy)?

People use many different words to describe this sensation. Most people feel it in the hands and feet first, beginning with their fingertips and toes. The tingling, pain, or numbness may move up from the fingers to the hands and from the toes to the feet. This is called a "stocking-glove" pattern (similar to how a person puts on gloves and stockings).

The most common symptoms people describe are these:

  • Tingling – a feeling of needles and pins, and burning.
  • Feeling a sudden, sharp "stabbing", pricking or "electric shock" pain feeling.
  • Decreased ability to feel changes in temperature, touch, pain or vibration.
  • Loss of balance, difficulty walking like slapping your feet, or stumbling and falling when your toes hit an uneven surface.
  • Clumsiness or dropping things.
  • Difficulty picking up objects, buttoning clothing, brushing teeth, writing or using a fork or spoon.
  • Hearing loss or ringing in the ears.
  • Jaw pain.
  • Constipation, difficulty urinating.
  • Weakness in arms or legs and other muscles.
  • Blurred vision, hoarseness or difficulty speaking.
Although some symptoms may develop suddenly after your treatment, the numbness and tingling may gradually build up. It can worsen with each chemotherapy treatment. Usually it is usually more intense right after a treatment and tends to get better just before the next one. Symptoms are normally at their worse 3-5 months after your last treatment. They may gradually get better over the next several months. However, in some cases it may not get better or totally go away.


What causes numbness and tingling (Peripheral Neuropathy)?

Numbness and tingling is the most common symptom of peripheral nerve damage. Some of the most common chemotherapy drugs known to cause peripheral neuropathy include:

  • Vincristine (Oncovin®)
  • Vindesine (Eldisine®)
  • Vinorelbine (Navelbine®)
  • Vinblastine (Velban®)
  • Platinol (Cisplatin®)
  • Paraplatin (Carboplatin®)
  • Eloxatin (Oxaliplatin®)
  • Paclitaxel (Taxol®)
  • Docetaxel (Taxotere®)
  • Bortezomib (Velcade®)
  • Thalidomide
  • Procarbazine (Matulane®)
  • Cytarabine (ARA-C®)
  • Vespide (Etoposide®, vp-16)
  • Alfa-interferon
High doses of chemotherapy tend to cause more numbness and tingling. Individuals at the greatest risk of developing numbness and tingling with chemotherapy are those people who already have conditions that increase their risk, these include:
  • Diabetes
  • Alcoholism
  • Severe malnutrition
  • Advanced age
  • Prior chemotherapy

What can I do about numbness and tingling (Peripheral Neuropathy)?

Although most of the time it is not possible to prevent early nerve damage, it is possible to prevent it from getting worse. The most important thing that you can do is to tell your healthcare provider immediately if feel any numbness and tingling. Then, you and your healthcare provider can talk about whether your treatment should be changed. Here are some tips you might find helpful:

ACTIVITY

  • Pay close attention when you walk. You may be able to tell if your toes and feet have been affected. This can help you avoid falls.
  • Turn lights on before entering a room.
  • Keep rooms bright enough that you can see all areas where you need to walk or do other activities.
  • Keep a night light in your room and along the path you walk during the night if you get up.
  • Move furniture at home so you have a clear pathway.
  • Remove objects from the floor to help prevent falls, such as clutter or throw rugs.
  • Avoid slippery wet floors. Wipe up liquids immediately.
  • Put a non-slip rubber mat or self-stick strips on the floor of the bathroom or shower.
  • Use over-the-tub handgrips or install shower grips.
  • Use soap dispensers instead of bar soap, which can easily slip out of your hands.
  • Use a non-breakable water thermometer to check your bath or dishwater temperature before you wash dishes or bathe. Mae sure that water is not hotter than 110 F (43.3C). This will help prevent injury to your kin. This is important if you are having trouble feeling changes in temperature.
  • Avoid extremes of hot and cold.
  • Avoid sudden chilling, such as reaching into a refrigerator or freezer, air conditioning in the summer, drinking ice-cold drinks, eating ice cream or other cold foods and cold showers.
  • Try wearing gloves and a scarf when opening a refrigerator or going into an air-conditioned room.
  • Use rubber gloves to wash dishes. The gloves will protect your hands from very hot water.
  • Use a potholder when cooking to avoid further injury to nerve endings.
  • Use a cane or walker if you are unsteady when walking or have weakness.
  • Wear sturdy shoes. Do not wear slippers and running shoes with thick soles.
  • Wear gloves and warm cotton socks in the winter.
  • Inspect your skin daily for abrasions, burns, and cuts. Carefully inspect your arms, legs, fingers and toes.
  • Consider having manicures if your hands are painful – but do not have your cuticles cut. This can increase your risk for infections.
  • Pay special attention when trimming your toenails. You may not feel small cuts on your toes. Have a pedicure or see a podiatrist for foot care.
  • Physical therapy may help with strengthening weak muscles.
  • Exercise- especially swimming and walking.
  • Occupational therapy to assist with daily activities
  • Massage is relaxing, which can help decrease pain.

COMMUNICATION

  • Discuss with your healthcare provider your current driving skills and ability to feel the gas and brake pedals, steering wheel and any changes in reaction time.
  • Your healthcare provider may refer you to occupational therapy to help with assistive devices, such as special pens, pencils and utensils. These assistive devices are designed so that you can hold them more easily. You may also need clothes and shoes with Velcro® straps and jewelry without fasteners. Inspect your skin daily for abrasions, burns and cuts; especially your arms, legs, fingers and toes.

DIET

  • Avoid cold beverages, chewing ice or using straws.
  • Drink at least 6-8 glasses of water a day to prevent constipation. Eat a high fiber diet. Talk to your healthcare provider about taking a stool softener or a laxative is you become constipated.

PSYCHOLOGICAL

  • Deep breathing, relaxation, and guided imagery can help with pain

How is numbness and tingling (peripheral neuropathy) managed?

Medications
Your healthcare provider may order a medication to help manage the pain and discomfort associated with peripheral neuropathy. Some to the medications that might be prescribed include:

  • Antidepressants may be used if your primary symptoms are tingling and burning pain. The use of antidepressants does not mean that your pain is imagined, or that you are depressed.
  • Antiseizure medication is commonly used if your primary symptoms include sharp, stabbing pains.
  • Topical creams are to be rubbed on the painful parts of the hands and feet. The most commonly used cream is Capsaicin (Zostrix®) made of chili pepper extract. The cream may burn when first applied to the skin but the burning passes with continued use.
  • Pain medication may be helpful when used with the antidepressants or anti-seizure medications. Lidocaine patches have a numbing effect and are placed directly on the skin over the painful areas.
Be sure to talk to your healthcare provider before starting any over the counter or other medication. Some medications may interact with your treatment, or with the drugs that you are taking to improve your numbness and tingling. You should never take any medications, herbal remedies, or other over the counter substances without talking to your healthcare provider first.

Non-medication
Several non-medication approaches have been reported to help people with numbness, tingling and pain these include:
  • Deep breathing, relaxation and guided imagery helpful particularly to with pain.
  • Acupuncture.
  • Physical therapy may help with strengthening weak muscles.
  • Exercise – especially swimming and walking.
  • Occupational therapy to assist with daily activities.
  • Massage is relaxing, which can help decrease pain.
  • Transcutaneous Electrical Nerve Stimulation (TENS) is a method of applying a gentle electric current to the skin to relieve pain.

What can family members and friends do to help me with my numbness and tingling?

Ask family members and friends to:

  • Prepare meals for you.
  • Help with daily household chores such as gardening or dishwashing.
  • Help with dressing and shopping to purchase shoes and clothes with Velcro® closures.
  • Get objects off the floor and make sure rugs are taped securely to the floor.
  • Help insert thermometers in sinks and tubes.
  • Install brighter light bulbs and make sure that all pathways are well lit.
  • Buy liquid soap in a dispenser instead of bar soap.
  • Help with transportation.
  • Do exercises with you, such as walking to improve strength, balance and coordination.

How can I talk to my family members about my numbness and tingling (Peripheral Neuropathy)?

Here are some ideas that may help you talk to family members and friends:

  • Be open and honest when telling family members and friends about difficulties you have with numbness and tingling.
  • Ask family members and friends for suggestions to help you function as close to your normal activity level as possible.
  • Tell family members and friends how the numbness and tingling is affecting your emotions and life.
  • Ask family members and friends how the numbness and tingling is affecting them.
  • Talk to your family and friends about any concerns regarding your safety or any help you need to perform your daily activities.

What should I report to my healthcare provider about my numbness and tingling?

If you experience any of the following symptoms, report them to your healthcare provider:

  • Changes in physical function, pain, numbness, prickling or tingling that interfere with your ability to care for yourself.
  • Moderate to severe weakness in your arms and legs that make it difficult to do daily activities.
  • Severe numbness, pain, burning or tingling in your hands or feet that make it difficult to do daily activities.
  • Changes in your sense of touch in your hands/fingers, or feet/toes or mouth area that make it difficult to do daily activities.
  • Difficulty in swallowing, breathing, drinking or chewing food, or muscle spasms in mouth /jaws, hands/fingers or feet/toes that makes daily activities difficult.
  • Any new problems with walking, balance or coordination.
  • Difficulty urinating or constipation.
  • Blurred vision, ringing in ears.
  • Any falls, burns or other injuries to your affected hands and feet, or any other body part.
  • Need for special equipment.
  • Stumbling or falling from numbness in feet.
  • Any new over-the-counter or prescription medications.

What things should I discuss with my healthcare provider about my numbness and tingling (Peripheral Neuropathy)?

If you are experiencing numbness and tingling, you should discuss the following with your healthcare provider at your next appointment:

  • Are the chemotherapy medications that I am taking likely to cause numbness and tingling?
  • Am I at special risk for developing numbness and tingling?
  • Does numbness and tingling usually go away after the treatment is finished?
  • If I get numbness and tingling will it interfere with my chemotherapy treatment?
  • Is there anything that you recommend to prevent numbness and tingling?
  • How have you managed numbness and tingling in other patients? What were the results?
  • Am I currently taking any medications that may make numbness and tingling worse?

Where can I get more information?

For more information, contact the people or organizations at the numbers or websites listed below:

References

  • Hausheer, F. H., Schilsky, R. L., Bain, S. & Berghorn, E. J. (2005). Diagnosis, management, and evaluation of chemotherapy-induced peripheral neuropathy. Seminars In Oncology Nursing, 33, 15-49.
  • Holley, S. (2002). A look at the problem of falls among people with cancer. Clinical Journal Of Oncology Nursing, 6(4), 193-197.
  • Lavoie Smith, E.M., Beck, S.L., Cohen, J. (2008). The total neuropathy score: A tool for measuring chemotherapy-induced peripheral neuropathy. Oncology nursing forum, 35(1), 96-102.
  • Smith, E.L., Whadon, M.B., & Bookbinder, M. (2001). Improvement for painful peripheral neuropathy. Seminars In Oncology Nursing, 18(1), 36-43.
  • Wilkes, G.M. (1999). Neurological disturbances. In C.H. Yarbro, M.H. Frogge, & M. Goodman (Eds.), Cancer Symptom Management, 2nd. Ed. (Pp. 344-81). Sudbury, Ma: Jones And Bartlett Publishers.
  • Wilkes, G.M. (2003). Peripheral neuropathy. In C.H. Yarbro, M.H. Frogge, & M. Goodman (Eds.), Cancer Symptom Management, 3rd Ed. (Pp. 77-96). Boston: Jones And Bartlett.
  • Wickham, R. (2007). Chemotherapy-Induced peripheral neuropathy: A review and implications for oncology nursing practice. Clinical Journal of Oncology Nursing, 11, 361-376.

Supportive evidence-based practice

  • Visovsky, C., & Daly, B.J. (2004). Clinical evaluation and patterns of chemotherapy-induced peripheral neuropathy. Journal Of American Academy Of Nurse Practitioners, 16(8), 353-359.
  • Visovsky, C., Collins, M., Abbott, L., Aschenbrenner, J. & Hart, C. (2007). Putting evidence into practice: Evidence-based interventions for chemotherapy-induced peripheral neuropathy. Clinical Journal of Oncology Nursing, 11(6): 901-913.

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