Chemotherapy-Induced Peripheral Neuropathy (CIPN): A Practical Management Guide
Understanding the causes, prevention, and treatment of CIPN provides self-management and clinical reference for patients in Hong Kong.
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Chemotherapy-induced peripheral neuropathy (CIPN) is a common and persistent side effect that affects the quality of life and functional performance of long-term cancer survivors. About 30–40% of patients receiving chemotherapyexperience ongoing neurological symptoms such as numbness, tingling, and sensory abnormalities. These symptoms can impair daily activities, balance, and mobility, and in severe cases force treatment discontinuation (Wikipedia).
Overview and Impact
Common Causative Drugs and Mechanisms
- Platinum agents (e.g., cisplatin, oxaliplatin): Damage the dorsal root ganglia and DNA, causing long-term sensory abnormalities and loss of motor reflexes (Wikipedia).
- Taxanes (e.g., paclitaxel, docetaxel): Affect axons and myelin sheaths, leading to pain and cutaneous hypersensitivity. Symptoms often worsen within 24–48 hours after administration (Wikipedia).
- Vinca alkaloids (e.g., vincristine): Disrupt microtubule structures, resulting in both sensory and motor nerve damage as well as muscle cramps (Wikipedia).
Current Prevention and Treatment Strategies
Preventive Strategies
According to the ASCO 2020 guidelines, there is no strong evidence to support most supplements for CIPN prevention, including B vitamins, alpha-lipoic acid (ALA), acetyl-L-carnitine, glutathione, and omega-3 fatty acids (Alberta Health Services; SpringerLink).
However, cryotherapy using cold gloves/booties during chemotherapy is recommended as it reduces blood flow to peripheral nerves, thereby lowering neurotoxic exposure, particularly in taxane-related CIPN (JWatch).
Treatment Strategies
Duloxetine is the only medication currently recommended by ASCO for relieving established painful CIPN. While it does not completely resolve symptoms, clinical evidence shows statistically significant improvement in pain (Wikipedia).
Supportive and Integrative Approaches
Nutritional and Supplement Approaches
- B Vitamins: Can restore nerve function in cases of deficiency, but preventive efficacy for CIPN remains unproven (SpringerLink).
- Alpha-Lipoic Acid (ALA): Possesses antioxidant and neuroprotective potential. It is effective in diabetic neuropathy but evidence for chemotherapy-related neuropathy is still limited (Verywell Health).
- Acetyl-L-Carnitine: Shown to help in certain neuropathies but demonstrates no significant benefit for CIPN, and may even be ineffective (ScienceDirect, Verywell Health).
Non-Pharmacological and Mind-Body Interventions
- Exercise and Rehabilitation: Balance and strength training can improve function and reduce symptoms. Early evidence supports yoga, sensorimotor training, and vibration therapy (SpringerLink; Annals of Oncology).
- Acupuncture and Traditional Therapies: Preliminary studies suggest potential benefits, but more randomized controlled trials (RCTs) are needed (SpringerLink).
Practical Guidance for Patients in Hong Kong
- Pre-treatment education and risk assessment
Patients should be informed of CIPN risks and possible interventions, especially those with pre-existing diabetes or neurological conditions. - Cold protection strategies
Use cold gloves/booties during taxane chemotherapy to minimize peripheral neurotoxicity. - Ongoing monitoring and evaluation
Apply standard assessment tools (e.g., CTCAE) for regular symptom monitoring, and adjust drug dosage or extend treatment intervals as necessary. - Integrate exercise and rehabilitation
Include balance training, light stretching, and mind-body practices (e.g., yoga, meditation) to enhance function and quality of life. - Supplements with caution, under medical supervision
When considering B vitamins, ALA, or other supplements, confirm safety and effectiveness with healthcare providers. - Duloxetine for pain management
Patients experiencing painful symptoms affecting daily life may consider duloxetine under physician guidance.
Conclusion
CIPN is a challenging but manageable chemotherapy side effect. With prevention, early detection, and integrative management strategies implemented simultaneously, patients can maintain treatment continuity and improve functional outcomes. For cancer patients in Hong Kong, active participation in symptom management and collaboration with the healthcare team can pave the way for practical and sustainable recovery pathways.
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References
- Derman, B. A., & ASCO Guideline Update. (2020). Prevention and Management of Chemotherapy‑Induced Peripheral Neuropathy in Survivors of Adult Cancers. J Clin Oncol. (ASCO 2020 guideline summary)ASCOPubs+5Wikipedia+5SpringerLink+5
- (2025, June). Chemotherapy‑induced peripheral neuropathy. SpringerLink+3Wikipedia+3U.S. Pharmacist+3
- J Watch. (2025, May). How to Prevent Chemotherapy-Induced Peripheral Neuropathy. JWatch
- Verywell Health. (2024, March). Supplements for Neuropathy: Do They Work? Verywell Health+1
- (2017). B Vitamin Complex and Chemotherapy‑Induced Peripheral Neuropathy. Curr Oncol Rep.solace.health+15SpringerLink+15SpringerLink+15
- Verywell Health. (2025, March). 8 Neuropathy Supplements for Nerve Pain Relief. Verywell Health
- (2021). Prevention of Chemotherapy‑Induced Peripheral Neuropathy: Current Clinical Data.SpringerLink
- Annals of Oncology. (2020). Central and especially peripheral neurotoxicities due to systemic antineoplastic therapy. Annals of Oncology