I had numbness in the region of terminal branches of radial nerve on my rt thumb but it was there before tx. I think HCV did it .
What is peripheral neuropathy and how is it related to chemotherapy (Interferon)?
The body's nervous system is divided into two major systems; the central nervous system and the peripheral nervous system. The peripheral nervous system is also divided into two major parts, the somatic nervous system and the autonomic nervous system. The somatic nervous system consists of peripheral nerve fibers that send sensory information to the central nervous system and motor nerve fibers that send signals to skeletal muscle. The autonomic nervous system controls smooth muscle of the viscera (internal organs) and glands.
Peripheral neuropathy results from some type of damage to the peripheral nerves. Certain chemotherapy drugs can cause peripheral neuropathy such as vinca alkaloids (vincristine), cisplatin, paclitaxel, and the podophyllotoxins (etoposide and tenoposide).
Other drugs used to treat cancer such as thalidomide and interferon also can cause peripheral neuropathy.
Individuals at greatest risk of peripheral neuropathy associated with chemotherapy are those with preexisting peripheral neuropathy from conditions such as:
* Severe malnutrition
* Previous chemotherapy
Symptoms of peripheral neuropathy:
* Numbness, tingling (feeling of pins and needles) of hands and/or feet
* Burning of hands and/or feet
* Numbness around mouth
* Loss of sensation to touch
* Loss of positional sense (knowing where a body part is without looking).
* Weakness and leg cramping or any pain in hands and/or feet
* Difficulty picking things up or buttoning clothes
Areas affected by neuropathy:
* Fingers and toes (most common)
o This may move gradually upward in a stocking-glove type fashion.
o May cause or worsen constipation
o May lead to conditions such as ileus (intestinal blockage).
* Other; face, back, chest.
Although some of the signs of neuropathy may appear suddenly, this change in sensation usually builds gradually and can worsen with each additional dose of chemotherapy. It is usually strongest right after a chemo treatment, but tends to lessen just before the next treatment. The symptoms usually peak about 3-5 months after the last dose of treatment is taken. The abnormal sensations may disappear completely, or lessen only partially; they may also involve less of the body. If neuropathy diminishes, it is a gradual process usually requiring several months. However, in some cases it may be irreversible and never diminish in intensity or the area of the body affected.
Things you can do (the patient) to minimize the effects of chemotherapy-based neuropathy:
Various techniques have been tried by patients and recommended by physicians to prevent, lessen the severity or treat chemotherapy side effects such as peripheral neuropathy. There is no "one-size-fits-all" regimen that works for everyone. Much of the treatment is based on trial and error, and finding what combination of interventions works for the individual.
* Report any unusual feeling you may have to your health care professional. Let them know if you are experiencing any of the above symptoms, so they can assess.
* Follow instructions regarding rest and delays in treatment.
* Be active in decisions regarding treatment versus quality of life.
Protection and Safety against Peripheral Neuropathy:
* Protect areas where sensation is decreased (example; do not walk around without foot wear). Wear thick socks and soft soled shoes.
* Extreme temperature changes may worsen symptoms.
* Wear warm clothing in cold weather. Protect feet and hands from extreme cold.
* Use care when washing dishes or taking a bath or shower do not let the water get too hot.
* Use potholders when cooking.
* Use gloves when washing dishes, gardening.
* Inspect skin for cuts, abrasions, burns daily, especially arms, legs, toes and fingers.
Simple Comfort Measures:
* Flexible splints
* Lotions and creams
Measures to relieve constipation induced by neuropathy:
* Eat foods high in fiber like fruits (pears, prunes), cereals, and vegetables.
* Drink two to three liters of non-alcoholic fluids (water, juices) each day; unless you are told otherwise by your doctor.
* Exercise twenty to thirty minutes most days of the week, as tolerated, and if okay with your doctor. A lot of patients find that walking for exercise is convenient and easy to do.
* If you have been prescribed a "bowel regimen," make sure you follow it exactly.
Other tips to combat or minimize chemo-based neuropathy:
* Some patients have found techniques such as deep breathing, relaxation and guided imagery helpful particularly to help with pain associated with neuropathy.
Drugs/treatment changes or therapies that may be prescribed by your doctor:
* Chemotherapy treatments may need to be interrupted or the dose adjusted to prevent worsening of this side effect.
* Use of vitamins particularly those in the B-complex family.
Control of neuropathic pain:
* Pain relievers (analgesics)
* Antidepressant (such as amitriptyline)
* Antiseizure medications (such as gabapentin)
* Physical therapy may help with strengthening of muscles that are weak. Usual exercises are range of motion, stretching and massage. Also can recommend assistive devices such as orthotic braces, canes, and appropriate splints.
* Occupational therapy may also be of help with assistive devices for activities of daily living.
* Therapies such as biofeedback, acupuncture, or transcutaneous nerve stimulation (TENS) may also be recommended/prescribed in severe cases.
When to call your doctor or health care professional:
* Notify your health care professional if you are experiencing the above symptoms.
* Unrelieved pain.
* Constipation despite laxative use.
Neuropathy is a medical term for any disease of the nerves. There are four major forms of neuropathy – polyneuropathy, autonomic neuropathy, mononeuropathy and the most common form, peripheral polyneuropathy – more commonly called peripheral neuropathy (PN). Peripheral neuropathy damages the nerves in the legs and arms. Usually the first area that PN affects are the feet and legs before the hands and arms.
This article will discuss the HCV-related form of peripheral neuropathy including the cause, symptoms, and treatments. (See below for a related article on PN.)
The exact cause of HCV-related PN is not completely understood, but there is some speculation that it could be caused by HCV RNA deposits in blood vessels that supply oxygen to the nerves, HCV infection of the nerves, an inflammation process in the nerves, and/or an HCV-related immune disorder. In the past it was believed that only people with cryoglobulinemia developed HCV-related PN but it has been proven that HCV-related PN can occur even in the absence of cryoglobulinemia. Studies have found that up to 15.3% of the HCV population has PN. The most common cause of PN is diabetes – in fact it is estimated that 34% of the diabetic population has PN. This compares to the prevalence of 2.4-8% in the general population.
The most common symptoms of PN are numbness, tingling, sharp pain or cramps, loss of balance and coordination, and pain. The pain is usually perceived as a steady burning, ‘pins and needles’, and/or like an electric shock. The symptoms of PN are usually worse at night. PN can also cause muscle weakness, loss of reflexes (especially in the ankles), and foot problems including sores and blisters that could potentially lead to infections of the skin and bone. PN doesn’t always progress or become worse; so just because a person develops symptoms of PN it doesn’t mean that it is going to become worse.
PN is usually diagnosed on the basis of physical symptoms and direct examination. It is important to know that many people with PN have no symptoms so it may be difficult to diagnose. An extensive examination of the foot is the most common way PN is diagnosed. A doctor will look for specific signs of PN including skin lesions, circulation problems, and test the degree of sensation by touching a filament to different areas of the foot or leg. There are other tests that can be done to determine the type and extent of nerve damage such as nerve conduction studies, electromyography, quantitative sensory testing, heart rate variability, ultrasound, and nerve or skin biopsy.
The most common treatment of PN consists of managing the symptoms. A medical provider may recommend aspirin, acetaminophen, or a non-steroidal anti-inflammatory drug (NSAID). There are other measures to control more severe symptoms including topical creams, opioid analgesics, tricylic antidepressants, anticonvulsants, and another class of antidepressants called serotonin norepinephrine reuptake inhibitors (SSNRI). Other measures include transcutaneous electrical nerve stimulation (TENS), which uses electricity to block pain signals, hypnosis, biofeedback and acupuncture. In general, antidepressants seem to work better to manage constant burning pain.
Treatment for most HCV-related extrahepatic manifestations is by treating the underlying cause (hepatitis C) with interferon. However, treatment of PN with interferon has produced mixed results and there is a chance that interferon could actually exacerbate existing PN. Generally, treatment of PN in someone with hepatitis C is done on a case by case basis evaluating the person with PN based on the severity of the PN and chances of responding to various treatments including interferon.
As discussed earlier PN usually affects the feet and legs first. Because NP can cause loss of sensation to the lower extremities it is of utmost importance that people with PN pay special attention to their feet. The loss of sensation caused by PN can lead to unrecognized cuts, blisters and other damage to the feet. If a condition or injury goes unchecked it could lead to infections and ulcerations that may spread to the bone. Severe bone infection can lead to amputation of the infected bone. There are many ways to take care of and protect your feet. The recommendations from The American Diabetes Association can be easily adapted to foot care for everyone with PN.
* Check all the areas of the feet every single day. Look for red spots, cuts, swelling and blisters. If you can not see the bottom of your feet, use a mirror or ask someone to inspect it for you.
* Be more active.
* Wash your feet everyday. Dry them carefully, especially between the toes.
* Moisturize your feet daily (but not between the toes).
* Never go barefoot – always wear comfortable shoes and socks. This is because people with PN can cut or damage their feet and may not even notice or feel the pain.
* Keep toe nails trimmed so that the nails don’t rub or cut nearby toes.
* Be careful not to expose your feet to hot and cold temperatures.
* Keep the blood circulating throughout the feet. The ADA recommends wiggling your ankles up and down for 5 minutes – two or three times a day. Don’t cross your legs for long periods of time.
* Stop smoking cigarettes.
* Check with your medical provider about the need for special shoes (orthotics).
For more information about peripheral neuropathy visit:
American Diabetes Association:
The Neuropathy Association:
you certainly want to start by getting a work up to be sure of your blood sugar ranges..
whether you are on tx or not, diebeties is a silent killer....and neuropathy is sometimes the first clue floks have.
Interferon can push blood sugars into diebetic range, so must be monitored.
Blood glucose should be drawn at each CBC.
Also note, we live in a computer age..problems in the wrists and thumbs are common to all repetitive motion jobs, and keyboards are no exception.
As a writer, I made the mistake of getting a deluxe office chair, to aide my in long hours abridging classic literatures...
Unfortunately, I was putting pressure on the ulnar nerve (elbows) in what I thought was a pretty cushy chair....not cushy enough I now have nerve damage numbing 2 fingers of each hand..
so lots of things can cause neuropathy, oh and lets not forget RIBA messes with nerve endings. It's good to take care of your nerves by staying away from caffienie and colas and making sure you get adequate calcium to protect your nyelin sheath coating each nerve.
old thread I know but good..
3 days tapering of tx...seriously worse neuropathy here..
anybody else had such an immediate reaction??
Dang..and just when I thought it was safe to pop my head out of my hole.......