Cancer Treatment-Related Peripheral Neuropathy

Cancer treatments, including chemotherapy, radiation therapy, and targeted therapies, have significantly improved patient survival rates. However, these treatments often come with adverse effects, one of the most challenging being Cancer Treatment-Related Peripheral Neuropathy (CIPN).

CIPN is a nerve disorder caused by certain cancer treatments, particularly neurotoxic chemotherapy drugs, which affect the peripheral nervous system. This condition can lead to pain, numbness, weakness, and balance problems, significantly impacting a patient’s quality of life and daily activities.

In addition to medication, treatment for CIPN in Cuba is by physical therapy and rehabilitation to improve mobility, reduce pain, and enhance overall quality of life with a focus on restoring function, preventing falls, and promoting nerve recovery.

Why Cuba

Treatment for CIPN in Cuba is tailored to the specific needs of each patient and depends on several factors, including the severity of neuropathy, the type of nerve damage, the underlying cancer treatment and its duration, individual health and medical history, and the functional limitations and daily impact of the condition. Cuban medical professionals take a comprehensive, multidisciplinary approach, combining medication management, physical rehabilitation, and alternative therapies to alleviate symptoms and improve nerve function. Physical therapy and electrotherapy are commonly used to enhance circulation, reduce pain, and promote nerve regeneration, while acupuncture and natural medicine are integrated into some treatment programs to provide additional relief. Nutritional support and lifestyle modifications are also emphasized, helping patients maintain nerve health and minimize further damage. The goal of treatment is to manage symptoms effectively, enhance mobility, and improve the overall quality of life, allowing individuals to regain independence and function more comfortably.

Causes of CIPN

CIPN develops when cancer treatments damage peripheral nerves, leading to nerve dysfunction. These peripheral nerves are responsible for sensory, motor, and autonomic functions, meaning that damage can result in a broad spectrum of symptoms ranging from mild discomfort to severe mobility limitations.

The most common cause of CIPN is chemotherapy, particularly drugs known to be neurotoxic. Other cancer treatments that can contribute to CIPN include:

• Radiation therapy, which may damage nerves in the treatment area.
• Surgical procedures, particularly those near nerve-dense areas.
• Targeted therapies and immunotherapies, which may cause inflammatory nerve damage.

Symptoms of CIPN

CIPN symptoms vary depending on the type and severity of nerve damage and the type of chemotherapy used. Symptoms can range from mild to severe and often develop gradually, starting in the hands and feet (a “stocking-glove” distribution) and may progress up the limbs.

Common Symptoms Include:

Sensory Symptoms

• Tingling or numbness (paresthesia) in hands and feet
• Burning or electric shock-like pain
• Increased sensitivity to touch, temperature, or pressure
• Reduced ability to feel textures or detect injuries

Motor Symptoms

• Muscle weakness in hands or feet
• Coordination and balance problems, increasing fall risk
• Difficulty grasping objects or performing fine motor tasks
• Muscle cramps or twitching

Autonomic Symptoms (Less Common)

• Dizziness due to blood pressure fluctuations
• Gastrointestinal issues (constipation, difficulty swallowing)
• Sweating irregularities

Diagnosis of CIPN

Diagnosing CIPN requires a comprehensive medical assessment to evaluate nerve function and exclude other potential causes of neuropathy.

Medical History & Symptom Assessment

• A detailed history of the patient’s cancer treatment, symptom onset, and progression is taken.
• Assessment of daily life limitations and pain levels using standardized neuropathy grading scales.

Neurological Examination

• Reflex testing: Reduced or absent reflexes may indicate nerve damage.
• Sensory testing: Includes evaluating vibration, temperature, and light touch sensitivity.
• Strength and balance assessments: To identify motor impairments and fall risks.

Electrophysiological Testing

• Nerve Conduction Studies (NCS): Measures nerve signal speed and strength.
• Electromyography (EMG): Evaluates muscle response to nerve signals.

Laboratory Tests

• Blood tests to rule out vitamin deficiencies, diabetes, or autoimmune disorders.
• Genetic testing may be considered for patients with a predisposition to nerve disorders.

Imaging Studies (MRI/CT Scans)

• Used if tumour-related nerve compression or structural abnormalities are suspected.

Physical Therapy and Rehabilitation for CIPN

Since CIPN has no definitive cure, treatment focuses on symptom management, improving mobility, and enhancing daily function. Physical therapy and rehabilitation play a crucial role in achieving these goals.

Physiotherapy and rehabilitation therapies are designed to bypass persistent motor and sensory deficits, retrain movement patterns, and enhance balance and gait stability, ultimately improving a patient’s ability to perform daily activities safely and effectively. Through targeted exercises and adaptive techniques, physiotherapy helps patients regain muscle control while minimizing strain on weakened or numb extremities.

Beyond addressing pain relief and mobility challenges, physical therapy and rehabilitation emphasizes energy conservation techniques to prevent excessive fatigue and allow individuals to maintain an active and independent lifestyle without overexerting themselves. It also incorporates pain management strategies, enabling patients to control neuropathic discomfort, reduce flare-ups, and prevent the development of compensatory movements that could lead to joint strain or postural imbalances.

A comprehensive CIPN physical therapy and rehabilitation program is guided by a multidisciplinary team of specialists, including physical therapists, occupational therapists, and pain management experts, ensuring that each patient receives a personalized, evidence-based approach to maximize recovery and long-term well-being.

Patients who qualify for CIPN physical therapy and rehabilitation include:

• Cancer survivors experiencing sensory or motor impairment due to chemotherapy.
• Patients with difficulty walking, balancing, or gripping objects.
• Individuals experiencing chronic pain, numbness, or weakness affecting daily life.
• Those with a high risk of falls due to loss of coordination and proprioception.
• Patients recovering from surgery or radiation-related nerve damage.

Balance and Coordination Training

• Patients with CIPN often struggle with balance, stability, and spatial awareness due to nerve damage affecting the feet and legs. Balance and coordination training aims to reduce fall risk and restore proper movement patterns.

Strength and Endurance Training

• CIPN often leads to muscle weakness and fatigue, particularly in the feet, legs, hands, and arms. Strength and endurance training are crucial for improving functional movement, preventing muscle atrophy, and restoring physical independence.

Sensory Re-education Therapy

• CIPN often causes loss of sensation, tingling, burning pain, or hypersensitivity in the hands and feet. Sensory re-education therapy helps stimulate nerve endings, retrain the brain’s response to sensory input, and reduce discomfort.

Electrical Stimulation Therapy

• Electrical stimulation therapy is used to activate muscles, improve nerve function, and block pain signals, helping CIPN patients restore mobility and reduce neuropathic discomfort.

Hydrotherapy (Aquatic Therapy)

• Water-based therapy is highly beneficial for CIPN patients due to the buoyancy, resistance, and hydrostatic pressure that water provides, making movement easier and less painful.

Occupational Therapy (OT) for CIPN

Occupational therapy is designed to help patients adapt to daily activities, enhance functional independence, and incorporate energy conservation techniques to manage fatigue and sensory impairments.

OT plays a crucial role in helping patients regain hand function, improve grip strength, and safely navigate daily tasks like dressing, cooking, and using tools or electronic devices.

Fine Motor Skill Rehabilitation

• Fine motor skill rehabilitation focuses on restoring hand dexterity, grip strength, and coordination affected by nerve damage. Techniques include hand therapy exercises, resistance training, and sensory re-education to improve control over tasks like writing, buttoning clothes, and using utensils.

Energy Conservation and Activity Pacing

• Energy conservation and activity pacing involve strategies to minimize fatigue, reduce strain, and optimize daily functioning by balancing rest with movement. Techniques such as breaking tasks into smaller steps, using assistive devices, prioritizing essential activities, and maintaining proper body mechanics help patients sustain energy levels and prevent overexertion.

Adaptive Equipment and Assistive Devices training

• Adaptive equipment and assistive devices training helps patients use ergonomic tools, braces, reaches, and orthotic supports to improve grip strength, mobility, and daily task performance. This training ensures safe and efficient use of assistive devices, reducing strain and enhancing independence in activities like dressing, cooking, and walking.

Pain Management & Sensory Re-education

• Pain management and sensory re-education in occupational therapy for Cancer Treatment-Related Peripheral Neuropathy (CIPN) focus on reducing nerve pain, hypersensitivity, and numbness through techniques like desensitization therapy, contrast baths, and vibration therapy. These approaches help patients regain sensory function, improve tolerance to touch, and manage neuropathic pain, enabling them to perform daily activities with greater ease and comfort.