Peripheral+Neuropathy

Peripheral neuropathy is caused by chemotherapy medications damaging peripheral nerve damage


**__Signs & Symptoms:__**

 * Pain
 * Patients may report shooting or stabbing pain but pain may also come and go.
 * Patients may report numbness or they may report a lessened ability to sense pressure, touch, or heat.
 * Burning feeling in extremities like hands and feet
 * Tingling feeling
 * Loss of feeling in extremities
 * Trouble using your fingers to pick up or hold things
 * Balance problems
 * Pressure or temperature may hurt more than usual
 * Muscle weakness
 * Trouble swallowing
 * Constipation
 * Trouble passing urine
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Blood pressure changes
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Decreased or no reflexes



<span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">**__Diagnostic Tests__**

 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Neuro exam
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">CT Scan
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">MRI
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Nerve Biopsy
 * Very rarely performed, can cause nerve damage
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">NCV
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Nerve conduction velocity test, measure speed of nerve impulse
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Measure degree of damage in nerve fibers
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Determines cause of nerve damage: demylinazation (slow transmission of nerve impulse) or axon damage (decreased impulse strength)
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">EMG (Electromyography)
 * Inserting needle into muscle to measure electric activity while muscle is active and when it is at rest.
 * Helps differentiate between muscle and nerve disorders

**__<span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Medications That Can Cause CINP __**<span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">:
<span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Platinum drugs like cisplatin, carboplatin, and oxaliplatin
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Taxanes including paclitaxel (Taxol) and docetaxel (Taxotere)
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Epothilones such as ixabepilone (Ixempra)
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Plant alkaloids such as vinblastine, vincristine, vinorelbine, and etoposide (VP-16)
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Thalidomide (Thalomid) and lenalidomide (Revlimid)
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Bortezomib (Velcade)

<span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">**__Nursing Interventions:__**

 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Teach patients the importance of medication compliance.
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Teach patient to avoid extreme temperatures.
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Teach patient to avoid shoes that are too tight.
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Teach patient to avoid alcohol, it may make CIPN worse.
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Teach diabetic patients the importance of controlling their diabetes & importance of controlling their blood sugar.
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Teach patients to use knives, scissors, box cutters, and other sharp objects gently and carefully.
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Teach patients to protect their hands by wearing gloves when they are cleaning, work outdoors, or do repairs.
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Teach patients to how to care for their feet.
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Instruct them to look at their feet once a day to see if you have any injuries or open sores. Instruct them to always wear shoes that cover your whole foot when walking, even at home.
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Teach patients to be sure that they have ways to support themselves if they have problems with balance.
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Teach patient how to use a walker or cane for extra support.
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">**Teach patient to advocate for themselves!**
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">**Teach patient to report signs & symptoms and concerns to health care provided.**

<span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">**__Medications for CIPN:__**
<span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Neurotin (Gabapentin): used to decrease numbness and tingling from nerve damage
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Steroids: used only for a short term treatment
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Patches or creams of numbing medicine: applied directly on source of pain
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Anti-depressant medicines: used to treat depression
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Anti-convulsant medicines: used as an off label treatment for nerve pain
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Opioids or narcotics: used for when pain is severe

<span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">**__Treatment Options:__**

 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Electrical nerve stimulation
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Occupational, physical, or relaxation therapy
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Massage
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Guided imagery
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Distraction
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Acupuncture
 * <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">Biofeedback

<span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">**-Excellent Nursing Article on Nursing Interventions for CIPN** <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">[]

<span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">-**Great Pain Control Resource for Patients** <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">[] <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;"> <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">**__Sources & References:__**
 * 1) <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">[]
 * 2) <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">[]
 * 3) <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">[|http://www.cancercare.org/publications/24-understanding_and_managing_chemotherapy_side_effects?gclid=CPbBr9KR3a0CFSwBQAods0w8kw#possible-side-effects]
 * 4) <span style="font-family: "Trebuchet MS",Helvetica,sans-serif;">[]