Peripheral Neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a cancer pain syndrome that is commonly experienced in the hands and feet.  Symptoms include sensory problems such as numbness, tingling, burning, shooting and stabbing, as well as motor symptoms such as muscle cramps and weakness.  CIPN is a common side effect of taxanes (paclitaxel, docetaxel), platins (cisplatin, oxaliplatin), vinka alkaloids (vincristine, vinblastine) and bortezomib.  These drugs are used to treat a variety of cancers, including breast cancer, ovarian cancer, colon cancer, lymphoma and multiple myeloma.

There have been numerous recently published papers stating the urgent need for effective treatments for CIPN.  Frequently prescribed medications include gabapentin or venlafaxine, or other opioid based pain treatments.  Unfortunately, most people do not benefit from these prescription drugs, or only experience mild improvement.  Many people are seeking out anything that holds promise to help them from the discomfort of this potentially debilitating symptom.

For a long time, medical literature stated the cause of CIPN was unknown, but much has been discovered in the past decade.  Chronic inflammation that ultimately damages nerves is the major cause.  Inflammation causes pain, and when inflammation is ongoing, pain receptors become more plentiful, resulting in the nervous system metaphorically being “on alert” at all times.  This hypervigilance ends up causing constant stress and pain, and other symptoms like burning and tingling.

Below is a list of natural treatments that have been the subject of clinical trials, that hold promise for the treatment of peripheral neuropathy.  Note that the treatments discussed below should not be taken preventatively, as some studies have shown that treatments during chemotherapy can make CIPN worse.  Always consult an experienced practitioner about proper dosages and other potential drug interactions.

1.  Omega 3 Fatty Acids

There have been several clinical trials looking at high dose omega 3 fatty acids, in particular DHA, showing good results for CIPN. A recent study looked at both omega 3 and vitamin E for the  treatment of symptoms, which were better than placebo.  Omega 3 fatty acids come primarily from fish, and come in the form of an oil.  The fatty nature of omega 3 fats is what holds their therapeutic potential, as these fats get directly incorporated into cells of the nervous system.  Some research has shown that omega 3 fats may contribute to myelogenesis (new formation of the myelin sheath, the protective cells around nerves).

2. Alpha Lipoic Acid

Two clinical trials have been conducted that looked at both oral intake, as well as intravenous administration, of alpha lipoic acid (ALA) for the treatment of CIPN with good success.  ALA is a potent antioxidant that reduces inflammation, and has been shown to be effective for diabetic neuropathy and other neurological conditions.  In fact, ALA has been approved as a drug for neuropathy in Germany since 1966.  ALA is a fat soluble complex, and therefore directly effects the nervous system.

3.  Glutathione

Glutathione is another antioxidant that works together with vitamin C to reduce inflammation and oxidative stress, one of the root causes of CIPN.  It can be taken both orally or intravenously, although intravenous use is more effective. Glutathione should likely not be used  during chemotherapy, and therefore should only be used once those treatments are complete. There has been mixed research regarding the efficacy of glutathione for CIPN, although in clinical practice it has been used with success.

4. Acetyl-L-Carnitine

Acetyl-L-carnitine (ALC) is involved in fat metabolism and has a strong affinity for the nervous system.  It is considered to be neuroprotective, and is also a potent antioxidant. It can help with the pain of neuropathy, and works by encouraging the regeneration of damaged nerves.  Most research has been with patients who take ALC in an oral supplement, but it can also be administered intravenously.

5.  Vitamin B12

Vitamin B12 is known to protect nerves against toxicity, and can also help with their regeneration.  Vitamin B12 for neuropathy is most commonly administered in a muscular injection. Some studies have been conducted where vitamin B12 was injected near nerves that are responsible for sensation in the hands and feet which showed an improvement in symptoms.  One study in patients with multiple myeloma showed improvement in symptoms with regular intramuscular injections.

6.  Electroacupuncture

Many patients seek out acupuncture for the treatment of CIPN, however, electroacupuncture seems to be more advantageous.  Electroacupuncture is when regular acupuncture needles are connected to a weak electrical current, which decreases inflammation and provides analgesia.  Electricity has a well established effect on the nervous system, ultimately resulting in the re-establishment of proper functioning of nerves.

The Ideal Treatment Plan

With the myriad of treatment options, where do you start? From experience, the best type of treatment plan is integrative.  Integrative medicine includes conventional therapies like pain medication and physical therapy.  With respect to natural treatments, the most effective treatment plans are ones that include physical treatments like acupuncture with internal medicine, like oral supplements and intravenous therapies.  Some results have been profound, with some patients experiencing a significant improvement after 2 weeks of IVs.

Knowledge is power, and knowing there are options for your symptoms can help you make decisions about your care.  Chemotherapy induced peripheral neuropathy can result in permanent symptoms, therefore early aggressive treatment yields the most success.  However, natural treatments like these can still be beneficial even after many years.