You have CANCER! Arguably, one of the most frightening statements you can find yourself on the receiving end of. This one word can, within seconds, cast a shadow of fear, uncertainty, questions, anger, and sadness upon a person and their entire family. But, we now also live in an age where perhaps many cancers can be cured or treated. Women with breast cancer are now living well beyond the five-year time-point, where at five years you are considered to be in “remission” and cancer free (where the risk of the cancer returning is reduced to single digit percentages). So with all of the remarkable advances in cancer treatment, why is it that we find remnants of the disease that persist long after the cancer is removed; case in point, chemotherapy-induced peripheral neuropathy.
What is Peripheral Neuropathy? The term “peripheral neuropathy,” “polyneuropathy,” and “neuropathy” are used interchangeably, even though each describes a unique entity of neurological disorders. Broadly, the terms refer to a generalized process affecting many of the peripheral nerves, while distal nerves are more greatly affected, specifically the nerves providing sensation to the fingers and toes.
What Causes Peripheral Neuropathy? While there are numerous factors that can cause peripheral neuropathy, some of the more common culprits include platinum-based chemotherapy drugs, long-term diabetes, alcohol abuse, and less common neurological accidents and/or disorders.
How Do I Know If I Have Peripheral Neuropathy? The symptoms of peripheral neuropathy usually include symmetrical loss of sensation, tingling, burning, and/or weakness. The symptoms are most prevalent in the fingers/hands and toes. However, some patients report having nerve symptoms in other locations as well. The symptoms can lead to difficulty walking, as we rely on our toes for movement, and trouble with daily activities that require intricate use of our hands, for example typing, opening containers, combing hair, etc. The pain and discomfort of peripheral neuropathy are often times accompanied by sleep and mood disturbances, fatigue, and difficulties carrying out everyday life activities.
Connect With Your Nerves
What is Chemotherapy-Induced Peripheral Neuropathy (CIPN)? Commonly used chemotherapy drugs that have been linked to CIPN include ixebepilone, the vincaalkaloids (vincristine and vinblastine), the taxanes(paclitaxel and docetaxel, and platinum-based regimens (cisplatin, oxaplatin, and carboplatin). While some patients with CIPN appear to recover after treatment is discontinued, the same is not true for patient treated with platinum-based drugs. Researchers have found that 30-40% of patients undergoing chemotherapy go on to develop signs and symptoms of peripheral neuropathy. CIPN generally begins to rear its ugly head after the first dose of chemotherapy and the symptoms tend to worsen with each additional treatment/cycle, simply put the symptoms and damage become additive. The unfortunate reality of platinum-based chemotherapy drugs is that the damage that is caused to the peripheral nerves is usually long lasting, if not permanent.
What are Possible Preventative Measures? According to the National Cancer Institute, the following preventative measures have shown promise in limited clinical trials.
Glutathione | Low levels of glutathione have been found in “wasting and negative nitrogen balance,” as observed in diseases such as cancer. Glutathione acts as an antioxidant reducing and eliminating reactive oxygen species.
Intravenous Calcium and Magnesium | In recent studies, researchers have found that only 4% of patients treated with IV calcium and magnesium, before and after each chemotherapy treatment, had to discontinue treatment due to neurotoxicity, compared to 33% that were treated with placebo only. Also, the same study found that of those patients treated with calcium and magnesium who went on to develop CIPN, the onset of symptoms was often delayed and lesser in intensity.
Interleukin-6 (IL-6) | IL-6 in the human body is secreted to stimulate the immune response, ie. during infection or other tissue damage (cancer therapy). In recent animal studies, IL-6 has been found to prevent peripheral nerve damage.
What are Possible Medical Treatment Options?
Gabapentin (Neurontin) | A medication used for both prevention of seizures and pain management. This drug is currently FDA-approved for use in seizure disorders and neuropathic pain following shingles. However, off-label use of the drugs has become common place in treatment of CIPN.
Valproate (Depacon) | This drug is an anticonvulsant (anti-seizure) medication used in the treatment of many disorders including anorexia, panic disorder, anxiety, post-traumatic stress disorder (PTSD), bipolar, and migraines. This drug is also prescribed “off-label” for the treatment of diabetic neuropathy and hence why it has also been used in CIPN.
Antidepressants | Another off-label use includes that for the antidepressant venlafaxine (Effexor) used in the treatment of CIPN. However, it is uncertain whether the drug actually combats the damage to the peripheral nerves or if the anti-depressant effects play the larger role.
Valproate (Depacon) | This drug is an anticonvulsant (anti-seizure) medication used in the treatment of many disorders including anorexia, panic disorder, anxiety, post-traumatic stress disorder (PTSD), bipolar, and migraines. This drug is also prescribed “off-label” for the treatment of diabetic neuropathy and hence why it has also been used in CIPN.
Antidepressants | Another off-label use includes that for the antidepressant venlafaxine (Effexor) used in the treatment of CIPN. However, it is uncertain whether the drug actually combats the damage to the peripheral nerves or if the anti-depressant effects play the larger role.
Harmonize With Your Body
What lifestyle changes can help?
Stay Active | It has long been proven that patients who are active, within reasonable means, before, during, and after chemotherapy treatment tend to do better overall. The thought is to “move your body every day,” even if it is a short walk, gentle stretching, or anything with reasonable intensity. Listen to your body.
N-Acetyl Cysteine | This supplement can help your body produce more glutathione, which as mentioned, is an incredible antioxidant that helps to detoxify your body as a whole.
Alpha Lipoic Acid | This antioxidant in most natural health stores is found to be effective in CIPN prevention.
Omega-3 Fatty Acids | This powerful antioxidant found in fish, but also available in tablets, reduces inflammation throughout all of the tissues of the body.
Integrate Complimentary Integrative Medicine
What can be expected during an osteopathic manipulative treatment?
Your osteopathic physician will begin by assessing your symptoms, both from a medical and lifestyle perspective. The physician will increase lymphatic circulation with various maneuvers to encourage elimination of waste and proper cleansing of the tissues. Strain patters will also be addressed and released to allow increased blood supply and nerve conduction to various tissues. Another technique that can be of benefit is myofacial release of strains in the fascia (connective tissue below the skin), muscles, and joints.
Your osteopathic physician will begin by assessing your symptoms, both from a medical and lifestyle perspective. The physician will increase lymphatic circulation with various maneuvers to encourage elimination of waste and proper cleansing of the tissues. Strain patters will also be addressed and released to allow increased blood supply and nerve conduction to various tissues. Another technique that can be of benefit is myofacial release of strains in the fascia (connective tissue below the skin), muscles, and joints.
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