Overview
Peripheral neuropathy most often affects the hands or feet with feelings of numbness, pain or burning, tingling or “pins and needles”.
Other symptoms may include muscle weakness, dizziness, balance issues, hearing loss or constipation.
Your treatment team may monitor you for signs of peripheral neuropathy, but tell them if you notice any symptoms. You may be referred to a neurologist for special tests to check how well the nervous system is working.
Symptoms
Peripheral neuropathy is a complex condition that can cause many different symptoms. This is because the damage can happen to any part of the peripheral nervous system, which includes sensory nerves, motor nerves and the autonomic nervous system. Often, more than one type of nerve is affected. Symptoms may be mild in the beginning, but often get worse over time, or with more cancer treatment.
Sensory nerves
Sensory nerves
What do these nerves do?
Control sensation and feeling including pain, temperature, touch, vibration, and where the body is moving (important for balance and coordination).
Symptoms of damage
- numbness – not being able to feel hands or feet
- tingling or “pins and needles” in hands or feet
- pain in hands or feet – this may be burning or shooting pain, “like walking on hot sand”
- hypersensitivity – where light touch feels more intense or is painful (especially at night)
- a reduced feeling of sensation or dulled feeling of touch
- confusion about temperature (e.g. feeling heat as cold, or not being able to tell if something is hot or cold)
- loss of awareness of where your body is in space, making you feel clumsy, especially when walking on uneven surfaces
- trouble keeping your balance when walking
- loss of hearing, or ringing in the ears (tinnitus)
Motor nerves
Motor nerves
What do these nerves do?
Control muscle movement.
Symptoms of damage
- finding it hard to do up buttons or pick up small objects
- trouble walking up stairs or getting up out of a chair
- muscle wasting or loss of muscle tone
- weakness (e.g. not being able to open a jar)
- cramps
- muscles twitching under skin
- poor handwriting
- unsteady way of walking (gait)
Autonomic nervous system
Autonomic nervous system
What do these nerves do?
Control blood pressure, heart rate, temperature and sweating, digestion, and bowel and bladder function.
Symptoms of damage
- constipation
- feeling bloated, or feeling full earlier than usual when eating
- diarrhoea
- dizziness when changing position from lying down to sitting up, or from sitting to standing
- changes to your vision, such as blurred vision
- trouble getting or keeping an erection
It’s important to tell your treatment team if you start having any symptoms of peripheral neuropathy or notice a change in your symptoms. Adjusting your cancer treatment may allow the nerves to recover and avoid permanent damage. Your team can also check if anything else is causing the symptoms.
My symptoms included acute pain, numbness, and sharp pins and needles in my hands and feet. Exercise and daily tasks became more difficult. I often felt unstable when walking and was prone to falls. I started slowly building up my fitness. I gradually got back to my tennis and long walks. It was very frustrating, but I was encouraged by small, incremental improvements.
Diagnosis
If you are having treatment that has a high risk of causing nerve damage, your treatment team will monitor you closely for early signs of peripheral neuropathy. Sometimes, peripheral neuropathy may be diagnosed after you tell your cancer specialist or general practitioner (GP) about your symptoms.
If your doctor suspects that you have peripheral neuropathy, they will check how the symptoms affect your daily life and may ask you to complete a symptom checklist. The doctor may also check your:
- awareness of where your body is moving – you close your eyes and answer questions about the position of parts of your body
- strength – you push against the doctor to check for weakness in your arms or legs
- sensation – your response to different types of sensations, including touch, temperature and sharp or blunt objects, will be checked
- reflexes – your ankles, knees and elbows are gently tapped with a small hammer to check their automatic movement
- balance and coordination – you may be asked to walk in a straight line or balance on one leg
- blood pressure – your blood pressure is measured when you are lying down and standing up to see if there is a difference.
In some cases, you may be referred to a neurologist (a specialist doctor who diagnoses and treats diseases of the nervous system). They may arrange a test called a nerve conduction study, to check how many cells are working and how quickly they send electrical signals along to the next cells.
Based on your symptoms and test results, your doctors may give the peripheral neuropathy a grade. This is usually a grade of 1 to 4, with grade 4 being the most severe and needing urgent attention.
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