Peripheral neuropathy and breast cancer

Peripheral nerves are nerves close to the surface of the skin.

They send messages between the brain and the spinal cord (the central nervous system) and the rest of the body.

Peripheral neuropathy happens when these nerves are damaged. It’s most common in the hands and feet.

Peripheral neuropathy in people with breast cancer is usually caused by chemotherapy.

The most common chemotherapy drugs that cause peripheral neuropathy are:

Other cancer treatments can cause peripheral neuropathy, such as surgery or radiotherapy to the armpit and lymph nodes. 

Peripheral neuropathy can also be caused by the cancer pressing on a nerve.

Whether you develop peripheral neuropathy will depend on:

• The drug or combination of drugs you’re having
• The dose you’re prescribed
• Whether you have had previous cancer treatment that causes peripheral neuropathy
• Whether you have diabetes or another condition that can cause nerve damage

You can discuss your risk of developing peripheral neuropathy with your treatment team. There is currently no treatment to prevent peripheral neuropathy.

Symptoms of peripheral neuropathy can include:

• Pain (often burning, stabbing or shooting)
• Numbness in your hands and feet
• Altered sensations in your hands and feet
• Loss of balance
• Pins and needles or tingling in your hands and feet
• A feeling of warmth or cold in your hands and feet
• Increased sensitivity to pain and hot or cold temperatures
• Difficulty doing ‘fiddly’ tasks such as doing up buttons
• Muscle weakness

Tell your treatment team if you develop any symptoms of peripheral neuropathy during or after treatment.

If you develop peripheral neuropathy, it’s important to try to prevent further damage. Your treatment team may talk to you about delaying, reducing or stopping treatment.

Symptoms are often mild to start with and can gradually get worse.

For some people the symptoms stay mild and go away soon after treatment stops. However, for most people, the symptoms will gradually improve over the weeks and months after treatment has finished.

Symptoms may take longer to improve and in some cases may not go away completely.

Treatment can be given to relieve nerve pain (neuropathic pain).

You may be given drugs that are usually prescribed for depression or epilepsy. These include amitriptyline, duloxetine, pregabalin and gabapentin.

Gels and creams may also be prescribed to help with pain relief.

Unlike many other types of pain, nerve pain isn’t usually relieved by common pain relief drugs such as paracetamol and ibuprofen.

You can also ask your treatment team to refer you to a specialist pain clinic. They may suggest other types of pain relief or alternative ways of trying to manage symptoms, for example physiotherapy or acupuncture.

You can search for a pain management service near you on the NHS website.

Avoiding injury

• Wear slippers and well-fitting shoes to protect your feet
• Take care when cutting nails and toenails
• Check the temperature of water with your elbow to make sure it isn’t too hot
• Use oven gloves when cooking to avoid burning your hands and gloves for gardening or washing up
• If your balance is affected, make sure your home is well lit and floors are clear of trip hazards (you can ask to be referred to a physiotherapist for advice about walking aids)
• Check regularly for injuries to your hands and feet so if you do hurt yourself it can be dealt with quickly (this may prevent the injury getting worse or developing an infection)

Other things that may help

• Keep your hands and feet warm by wearing socks and gloves
• Wear seamless bamboo socks for comfort
• To improve sleep, try silk or bamboo sheets
• If you’re having difficulty with fiddly tasks such as fastening buttons, ask for a referral to a physiotherapist or occupational therapist
• If you feel light-headed or dizzy, stand up slowly and make sure the dizziness has passed before you start to walk around

Some people find exercise improves circulation and coordination, and can help with symptoms of peripheral neuropathy.

Others have found complementary therapies such as acupuncture, massage and reflexology helpful.

Currently there’s no proven way to prevent or reverse peripheral neuropathy, though studies are looking into this.

You’re legally required to inform the Drivers and Vehicle Licensing Authority if you have peripheral neuropathy.