If you’re living with leukemia, you may wonder if it can cause an uncomfortable condition called neuropathy (nerve damage). While neuropathy isn’t a common symptom of leukemia, some cancer medications can cause it as a side effect. Chemotherapy for leukemia, for example, can cause chemotherapy-induced peripheral neuropathy (CIPN) — a type of nerve damage that affects the peripheral nerves (nerves outside the brain and spinal cord), often in the hands and feet — which can lead to burning, tingling (“pins and needles”), numbness, or pain.

In this article, you’ll learn more about CIPN, what causes it, and ways to find relief.

What Is Peripheral Neuropathy?

Your nervous system has two main parts. Your brain and spinal cord make up your central nervous system. The other part, the peripheral nervous system, includes all the nerves that branch off from your spinal cord and connect the central nervous system to the rest of your body. Peripheral nerves play a role in movement, sensation, and automatic body functions (functions your body does without you thinking about them), such as digestion, heart rate, and sweating.

Peripheral neuropathy is a condition that occurs when peripheral nerves are damaged. It can cause pain, numbness, or weakness. It often starts in the hands or feet and may spread up the arms or legs over time. People with peripheral neuropathy may experience:

• Tingling, warmth, burning, sharp, or throbbing feelings in the hands or feet
• Weakness or numbness
• Leg and foot cramps
• Difficulty maintaining balance
• Increased or decreased skin sensitivity
• Changes in muscle strength (muscle weakness)
• In some cases, bowel or bladder problems

Some chemotherapy drugs can damage nerves. Between 30 percent and 40 percent of people who receive neurotoxic chemotherapy (drugs that can harm nerves) develop CIPN. Symptoms often start gradually. They can be constant or come and go. They may improve several months after treatment ends. However, in some severe cases, the damage may be permanent.

How Can Peripheral Neuropathy Impact Someone’s Daily Life?

The effects of peripheral neuropathy can prevent you from resting comfortably or doing activities you once enjoyed.

MyLeukemiaTeam members shared their personal experiences with CIPN.

“After a year and a half of treatment, my daughter developed a new symptom of leg pain, which started two months ago and is becoming worse by the day,” a MyLeukemiaTeam member said. “The pain typically occurs in the early morning, beginning around 2 a.m. She can’t settle while she’s in discomfort. Pain relievers help, but her pain occurs on a daily basis.”

“I have numbness from my toes to my knees, in my fingertips, frayed nerves in my eyes, and hearing loss to the point that I had to start wearing hearing aids,” another MyLeukemiaTeam member said. “I can’t garden anymore.”

What Causes Peripheral Neuropathy?

Some leukemia treatments can irritate or damage nerves. In leukemia care, the medicines most often linked to nerve problems include:

• Vinca alkaloids, especially vincristine sulfate
• Nelarabine (Arranon)
• Arsenic trioxide (Trisenox)

Some medicines used for other blood cancers (like myeloma or some lymphomas) can also cause nerve problems, so it’s important to ask whether any of your drugs are neurotoxic (likely to affect nerves).

If you’ve received chemotherapy or you’re about to, speak with your oncology team about the risk of CIPN and what symptoms to watch for during treatment and afterward.

Radiation isn’t the first treatment for leukemia. However, it may be used along with other therapies in certain situations. Radiation can relieve pain in specific areas, such as when leukemia affects tissues outside the bone marrow or causes a painful, localized problem. Unfortunately, radiation can also damage nerves and cause peripheral neuropathy. This side effect may not become noticeable until months or even years after treatment.

Other Causes of Peripheral Neuropathy

There are many causes of peripheral neuropathy other than leukemia treatment, including:

• Diabetes
• Certain autoimmune diseases (when the immune system mistakenly attacks the body), including celiac disease, lupus, and Guillain-Barré syndrome
• Certain infections, including COVID-19, hepatitis, herpes zoster (shingles), Lyme disease, or human immunodeficiency virus (HIV) infection
• Hereditary and inflammatory neurologic conditions (conditions that can affect nerves and may run in families or involve inflammation)
• Kidney failure
• Nutritional deficiencies (particularly B vitamins)
• Trauma or injury to the nerves
• Certain medications (including some antibiotics)

In almost one-third of cases, peripheral neuropathy is idiopathic, meaning the cause is unknown.

Ways To Treat or Relieve Neuropathy Pain

There’s no guaranteed cure for CIPN, but if your leukemia treatment causes it, there are ways to manage symptoms and help protect your safety and daily function.

Medication

One medicine with the strongest evidence and guideline support for painful chemo-related nerve pain is duloxetine (an antidepressant that can also treat nerve pain).

Some people try gabapentin or pregabalin, but studies haven’t shown clear benefit for this type of nerve pain, so they aren’t routinely recommended.

Muscle relaxers and steroids might help this kind of pain, though evidence is limited.

Topical creams or patches (like lidocaine or capsaicin) may help some people, but research is mixed.

Always check with your cancer team to make sure a medicine is safe with your treatment.

Physical and Occupational Therapy

If you have the stamina to participate, physical therapy can increase strength and improve balance. Occupational therapy can help with fine motor skills (small movements, like buttoning clothes or using utensils). Regular exercise, with your physician’s guidance, may also help with strength, balance, and mood, although research is still developing for CIPN. Ask your cancer team about what level of activity is safe for you.

Alternative Therapies

Some people may try complementary therapies like acupuncture, massage, and relaxation techniques. Research on these therapies for chemo-related nerve pain is mixed — some people feel better, but they are not proven treatments.

Since leukemia and chemotherapy may cause low platelet counts, easy bleeding or bruising, or low white blood cell counts (which can raise infection risk), be sure to consult with your doctor before pursuing alternative therapies.

If you have an underlying condition that can cause or worsen peripheral neuropathy, be proactive about managing your condition to prevent further nerve damage.

Safety Measures for Peripheral Neuropathy

If you develop peripheral neuropathy, you may be less able to feel sensations like heat, cold, or pain in your hands or feet. This can raise your risk of burns, cuts, blisters, and falls.

Here are a few safety measures you can take at home to prevent injuries:

• Keep your living space, including hallways and stairs, free of clutter and well lit. Clean up spills promptly. Remove area rugs or secure them with nonslip backing, since they can be a tripping hazard.
• Install handrails on both sides of staircases.
• Place grab bars or hand grips and a nonskid mat inside the shower or tub.
• Use a thermometer or set the thermostat on your water heater to ensure your water temperature is not above 110 degrees Fahrenheit. Test bath water with your elbow or a thermometer if your feet or hands feel numb.
• Avoid tight-fitting shoes. Choose supportive, well-fitting shoes, and check your feet daily for discoloration, blisters, or sores (especially if you have numbness).
• Take care with sharp or breakable items, like dishes, box cutters, knives, or scissors. Use a pot holder when handling hot pots and pans. Consider cut-resistant gloves if you cook often.
• If you drive, make sure you can feel the steering wheel and quickly move your feet from the gas to the brake pedal.
• If you have unsteady balance, consider using a cane or walker for stability.

When To Talk to Your Doctor About Neuropathy With Leukemia

You can speak to your cancer team about CIPN before you start treatment and throughout treatment.

Cryotherapy (cooling the hands and feet) and light compression have mainly helped prevent or lessen neuropathy with taxane drugs used for other cancers, like breast cancer. But taxanes aren’t standard leukemia medicines. For leukemia drugs such as vincristine or nelarabine, there isn’t a proven way to prevent nerve damage outside a clinical trial.

Always keep in touch with your cancer care team about your symptoms and side effects. Let your oncology team know if you develop symptoms of peripheral neuropathy during treatment. To help prevent further nerve damage, your doctor may recommend a lower dose of chemotherapy, a pause in treatment, or a switch to a different medicine when possible.

Join the Conversation

On MyLeukemiaTeam, people share their experiences with leukemia, get advice, and find support from others who understand.

Did you experience peripheral neuropathy after chemo? What helped your discomfort? Let others know in the comments below.