What is chemotherapy-induced peripheral neuropathy (CIPN)?

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What is chemotherapy-induced peripheral neuropathy (CIPN)?

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of certain chemotherapy drugs used in cancer treatment. It involves damage to the peripheral nerves, which are responsible for transmitting signals between the central nervous system (the brain and spinal cord) and the rest of the body. CIPN can lead to a variety of sensory, motor, and autonomic symptoms, significantly impacting a patient’s quality of life.

Causes of CIPN

CIPN is caused by the neurotoxic effects of chemotherapy drugs. These drugs can damage the structure and function of peripheral nerves in several ways, including:

Direct Neurotoxicity: Some chemotherapy agents directly damage nerve cells or their supporting structures. This damage can occur in the nerve cell body, axon (the long, thread-like part of a nerve cell), or the myelin sheath (the protective covering of the nerve).
Disruption of Cellular Function: Chemotherapy drugs can interfere with cellular processes critical for nerve function, such as microtubule formation, mitochondrial function, and ion channel function.
Oxidative Stress and Inflammation: Chemotherapy can induce oxidative stress and inflammatory responses, leading to nerve damage.
Vascular Damage: Chemotherapy may also affect the blood supply to nerves, leading to ischemia (reduced blood flow) and subsequent nerve damage.

Chemotherapy Drugs Commonly Associated with CIPN

Several chemotherapy drugs are known to cause CIPN, including:

Platinum Compounds: Such as cisplatin, carboplatin, and oxaliplatin.
Taxanes: Such as paclitaxel and docetaxel.
Vinca Alkaloids: Such as vincristine and vinblastine.
Proteasome Inhibitors: Such as bortezomib.
Other Agents: Such as thalidomide and certain immune checkpoint inhibitors.

Symptoms of CIPN

The symptoms of CIPN can vary widely and depend on the type and extent of nerve damage. They can include:

Sensory Symptoms:
- Numbness, tingling, or burning sensations, often starting in the hands and feet (glove-and-stocking distribution).
- Sharp, shooting, or electric shock-like pain.
- Increased sensitivity to touch, temperature, or pressure (allodynia).
- Loss of sensation, leading to difficulties in feeling textures, temperature changes, or pain, which can increase the risk of injuries.
Motor Symptoms:
- Muscle weakness, cramps, or twitching.
- Difficulty with fine motor skills, such as buttoning clothes or writing.
- Problems with balance and coordination, leading to an increased risk of falls.
Autonomic Symptoms:
- Changes in blood pressure and heart rate.
- Gastrointestinal issues, such as constipation or diarrhea.
- Sexual dysfunction or bladder control issues.

Diagnosis of CIPN

Diagnosing CIPN involves a combination of medical history, symptom assessment, and specific tests to evaluate nerve function:

Medical History and Physical Examination: Assessment of symptoms, their onset, and progression, along with a review of the chemotherapy regimen and dosage.
Neurological Examination: Includes tests for reflexes, muscle strength, and sensory function.
Electrodiagnostic Testing: Nerve conduction studies and electromyography (EMG) can help assess the extent of nerve damage.
Quantitative Sensory Testing: Measures response to various stimuli to evaluate sensory nerve function.

Management and Treatment of CIPN

Managing CIPN focuses on relieving symptoms, preventing further nerve damage, and improving quality of life:

Symptom Management:
- Medications: Pain relievers, anticonvulsants, and antidepressants may be prescribed to manage neuropathic pain.
- Topical Treatments: Creams or patches containing lidocaine or capsaicin may help reduce pain.
Physical Therapy: Helps maintain muscle strength, improve coordination, and prevent falls.
Occupational Therapy: Assists patients in adapting to changes in motor skills, making daily activities easier.
Lifestyle Modifications: Regular exercise, a balanced diet, and avoiding alcohol and tobacco can improve overall health and potentially alleviate symptoms.
Dose Adjustment or Drug Substitution: In some cases, adjusting the chemotherapy dose or switching to a less neurotoxic agent may be considered to prevent worsening of CIPN.
Alternative Therapies: Some patients find relief through acupuncture, massage, or other complementary therapies.
Psychological Support: Dealing with chronic symptoms and the stress of cancer treatment can be challenging, so psychological support or counseling may be beneficial.

Prognosis and Long-term Impact

The severity and duration of CIPN can vary. While some patients experience improvement or resolution of symptoms after completing chemotherapy, others may have long-term or permanent nerve damage. Early detection and management are crucial to minimize the impact of CIPN on a patient’s quality of life and daily functioning. Regular follow-up with healthcare providers is important for monitoring symptoms and adjusting treatment as needed.

Jodi Knapp