# Peripheral neuropathy (chemotherapy-induced)

Source: https://onco.cc/terms/peripheral-neuropathy/  
OnCo record `peripheral-neuropathy` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Nerve damage from chemotherapy that causes numbness, tingling and pain in the hands and feet, and sometimes weakness or hearing loss. It builds up with each dose, can be permanent, and is the main reason oxaliplatin, taxanes and vincristine have to be stopped or reduced.

## Summary

Oxaliplatin (acute cold-triggered and chronic cumulative), paclitaxel, docetaxel, vincristine, bortezomib, brentuximab vedotin and other MMAE ADCs, and cisplatin (which also damages hearing, especially in children, prevented by sodium thiosulfate) are the main culprits. There is no proven preventive drug; duloxetine helps painful neuropathy, and dose reduction or stopping is the only reliable measure, which is why 3 rather than 6 months of adjuvant oxaliplatin (IDEA) was so consequential. Neuropathy is graded by function (grade 2 limits instrumental activities, grade 3 self-care) and often reported by patients as more severe than by clinicians. Cisplatin eligibility in bladder cancer includes absence of neuropathy and hearing loss.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: neuropathy; peripheral neuropathy; chemotherapy-induced peripheral neuropathy; CIPN; sensory neuropathy; motor neuropathy; neuropathic; numbness; tingling; paraesthesia; paresthesia; cold-induced neuropathy; cumulative neuropathy; neurotoxicity; neurotoxic; ototoxicity; hearing loss; tinnitus; neuropathies

## Notes

- Triple-negative breast cancer: paclitaxel is the usual cause. Macmillan says to tell the team about any new tingling, numbness or pain early, because the doctor may lower the dose or stop the drug, and that for most people symptoms slowly improve once treatment ends, sometimes worsening for a few weeks first (coasting). Practical points from Macmillan: test bath water with your elbow, use oven gloves, and take care with balance and falls.
- The ASCO guideline (Loprinzi 2020) found no agent prevents chemotherapy neuropathy and that duloxetine is the only drug with evidence for established painful neuropathy, with limited benefit.
- Pancreatic cancer: oxaliplatin (in FOLFIRINOX and NALIRIFOX) and nab-paclitaxel are the causes. Pancreatic Cancer UK says it may be worse in the cold, that gloves, warm socks and avoiding cold food and drinks help, that it normally improves after treatment but can worsen in the first months, and to tell the team early so the dose can be changed before it becomes long term. Macmillan adds that oxaliplatin can rarely cause a throat spasm in the cold in the first days after a dose.
- The ASCO guideline (Loprinzi 2020) found no agent prevents chemotherapy neuropathy and that duloxetine is the only drug with evidence for established painful neuropathy.
- Oxaliplatin (in FOLFOX and CAPOX) is the main cause in bowel cancer. Macmillan says the numbness, tingling or pain in hands and feet is often made worse by cold during treatment, so keep warm, avoid iced drinks, take care opening the fridge and use gloves for frozen food; rarely oxaliplatin causes a spasm around the voicebox with difficulty swallowing or breathing in the first days after treatment, and the next doses may then be given over 4 to 6 hours.
- Bowel Cancer UK says symptoms can appear during the cycle and for up to two weeks afterwards, may get worse before they get better, and in some people last months or years, making writing, picking up small items and walking difficult. NICE NG151 asks teams to monitor prolonged sensory symptoms after platinum chemotherapy because they can be a sign that the dose needs reducing to minimise future permanent neuropathy.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Chemotherapy-induced_peripheral_neuropathy
- Wikipedia: https://en.wikipedia.org/wiki/Chemotherapy-induced_peripheral_neuropathy
- Macmillan: peripheral neuropathy: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/peripheral-neuropathy
- NHS: peripheral neuropathy: https://www.nhs.uk/conditions/peripheral-neuropathy/
- Loprinzi et al., ASCO guideline update on chemotherapy-induced peripheral neuropathy (JCO 2020): https://doi.org/10.1200/JCO.20.01399
- Pancreatic Cancer UK: side effects of chemotherapy: https://www.pancreaticcancer.org.uk/information-and-support/treatments-for-pancreatic-cancer/chemotherapy/side-effects-of-chemotherapy/
- Macmillan: FOLFIRINOX: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/folfirinox
- Macmillan: oxaliplatin: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/oxaliplatin
- Bowel Cancer UK: long term and late side effects: https://www.bowelcanceruk.org.uk/about-bowel-cancer/living-with-and-beyond-bowel-cancer/long-term-and-late-side-effects/
- NICE NG151: colorectal cancer, recommendations: https://www.nice.org.uk/guidance/ng151/chapter/Recommendations

## Connected records

- terms: [Dose reduction, interruption and discontinuation](https://onco.cc/terms/dose-modification/), [FOLFOX, FOLFIRI, FOLFIRINOX and CAPOX](https://onco.cc/terms/folfox-family/), [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [Living with FOLFIRINOX, NALIRIFOX and gemcitabine with nab-paclitaxel](https://onco.cc/terms/chemotherapy-side-effects-pancreatic/), [Living with FOLFOX, CAPOX, FOLFIRI and the EGFR antibodies](https://onco.cc/terms/chemotherapy-side-effects-colorectal/), [Proteasome inhibitor (bortezomib, carfilzomib, ixazomib)](https://onco.cc/terms/proteasome-inhibitor/), [Taxanes (paclitaxel, docetaxel, nab-paclitaxel)](https://onco.cc/terms/taxane/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- drugs: [Bortezomib](https://onco.cc/drugs/bortezomib/), [Brentuximab vedotin](https://onco.cc/drugs/brentuximab-vedotin/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Sodium thiosulfate (otoprotectant)](https://onco.cc/drugs/sodium-thiosulfate/), [Vincristine](https://onco.cc/drugs/vincristine/)
- trials: [CONKO-003 (OFF)](https://onco.cc/trials/conko-003/), [MPACT](https://onco.cc/trials/mpact/), [PANOPTIMOX-PRODIGE 35](https://onco.cc/trials/panoptimox-prodige-35/)
- technologies: [Acupuncture for chemotherapy-induced neuropathy](https://onco.cc/technologies/acupuncture-chemotherapy-neuropathy/), [Balance, dizziness and falls after cancer treatment](https://onco.cc/technologies/rejuv-rehab-balance-vestibular/), [Frozen gloves, socks and compression for taxane nail and nerve damage](https://onco.cc/technologies/frozen-gloves-compression-taxane/), [Glutamine for mucositis and neuropathy](https://onco.cc/technologies/glutamine-mucositis-neuropathy/), [Nerve damage from chemotherapy: what recovers, and what helps](https://onco.cc/technologies/cipn-recovery-and-treatment/), [Scrambler therapy (Calmare) for chemotherapy nerve pain](https://onco.cc/technologies/scrambler-therapy/), [Sleeping tablets after cancer: what they do and what they do not](https://onco.cc/technologies/rejuv-mind-sleeping-tablets-after-cancer/), [Tai chi and qigong](https://onco.cc/technologies/tai-chi-qigong/)

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