Debbie Aufdenberg from Burfordville, Missouri, started experiencing pain after her second dose of Taxol, a chemotherapy drug, for her breast cancer in 2015.

“I had pins and needles pain in my feet, hands, and mouth. My oncologist lowered my dose and I continued the treatment,” she told The Epoch Times. But the flare-ups did not go away.

She was diagnosed with chemotherapy-induced peripheral neuropathy, or CIPN, which affects the nerves outside the brain or spinal cord. “Sometimes my feet or hands would have a burning sensation, like a sunburn. Pins and needles pain came now and then but gradually became less often.”

Her cancer returned in 2018, and she received CMF (cyclophosphamide, methotrexate, and 5-fluorouracil) chemotherapy. She started experiencing more nerve pain halfway through. Aufdenberg started using a cane during treatment because of the pain and the need for extra stability.

Chemotherapy is considered a first line of treatment for cancers, alongside radiation and surgery for most cancers. It targets cancer cells but also damages healthy ones, leading to severe side effects, including nerve pain, which affects nearly 70 percent of patients.

A recent global study found that four in 10 cancer patients experience CIPN.

Added Burden of Cancer Treatment

The new study, published in Regional Anesthesia & Pain Medicine, pooled data from almost 80 studies across nearly 30 countries, analyzing about 11,000 patients with chemotherapy-induced neuropathy. Among them, more than 40 percent reported severe and persistent nerve pain lasting at least three months.

Those treated with platinum-based chemotherapy like Cisplatin and taxanes like Paclitaxel were the most affected by these nerve pains, which lasted for at least three months. Platinum-based chemotherapy drugs work by damaging the DNA of cancer cells, while taxanes stop cancer cells from replicating.

Nerve pain from chemotherapy was the most common in lung cancer patients and least common in patients with with ovarian cancer.

Compared to patients treated with the above chemotherapy drugs, those receiving combination chemotherapy regimens reported lower neuropathy rates.

Gender did not influence the likelihood of nerve pain, but prevalence was higher in Asia (almost 50 percent) than in Europe (over a third).

Researchers link higher neuropathy rates in lung cancer patients to complex treatments. These patients frequently use multiple and prolonged chemotherapy cycles.

People who take higher doses of chemotherapy drugs, have pre-existing nerve damage, or take other nerve-damaging medications are at an increased risk of CIPN. Patients with Type 2 diabetes, who are already prone to diabetic neuropathy due to high blood sugar damaging their nerves, are at higher risk of experiencing nerve damage from chemotherapy drugs.

“While neuropathy from cancer treatment most commonly involves numbness and tingling, pain is common as well. The pain is often described as burning, pricking, or electric like in nature,” Dr. Joseph Vega, who isn’t part of the study, told The Epoch Times. He is a supportive care medicine physician at City of Hope, a national cancer research and treatment organization.

When it comes to outlook, Vega shared, “I tell patients that, over time, one-third will see their symptoms completely resolve, one-third will experience some improvement but not full recovery, and one-third won’t see any improvement.”

“The most common offending agents are the platinum-based, taxane-based, and vinca alkaloid-based drugs like Vincristin. Some immunomodulators can cause neuropathy symptoms, too,” Vega said.

Doctors commonly prescribe platinum-based chemotherapy for lung, testicular, ovarian, bladder, head & neck, colorectal, and esophageal cancers. Meanwhile, taxanes are primarily used to treat breast, ovarian, lung, prostate, and gastric cancers.

How Chemotherapy Damages Nerves

Platinum-based chemotherapy drugs can damage nerve cells in the spinal cord, leading to long-lasting nerve pain. Unlike typical neuropathy, which starts in the hands and feet, this type of nerve damage can affect any part of the body, following no clear pattern.

Taxane-based chemotherapy drugs disrupt microtubules, which are proteins that maintain the shape of nerves and serve as tracks for the delivery of brain neurotransmitters and nutrients. This typically results in sensory problems in the toes and fingertips and weakness.

Peripheral neuropathy can impact both movement and sensation, causing pain, numbness, weakness, and balance issues.

Most patients experience numbness and tingling, but those who experience pain may become unable to work and suffer significant financial burden from the lost income and expenditure on treatment.

For severe cases, the symptoms can be intolerable, and patients often describe having a hard time wearing shoes, walking, or even having difficulty sleeping at night due to pain,” Vega said.

Managing the Nerve Pain

The management of neuropathy should be individualized and holistic, addressing both symptoms and its broader impact on a patient’s daily life, according to Dr. Jessica Cheng, a physiatrist at City of Hope Orange County in Irvine, California, and a specialist in cancer prehabilitation and rehabilitation, who isn’t part of the study.

A Range of Interventions

Symptom relief often includes a range of interventions, including pain-relieving topicals, medications, therapeutic devices, and acupuncture, she said. Meanwhile, other conservative treatments may include physical therapy, occupational therapy, and general exercises with adaptations for safety.

Vega usually recommends alpha lipoic acid (ALA), an antioxidant, daily for people with mild symptoms. However, duloxetine, which acts by increasing the levels of serotonin and norepinephrine in the brain, is the first line of treatment for those with moderate to severe symptoms. Other medications include gabapentin and pregabalin, both of which are anticonvulsants.

Medication Management

When these medications don’t work, Vega would prescribe moderate to strong opioids.

“While efforts to reduce opioid use exist due to risk of addiction or misuses, for cancer patients, these medications may be the only way for patients to continue to tolerate their cancer-directed treatments and preserve quality of life,” he added.

Combining Treatments

Patients often turn to a combination of treatments to manage pain, including conservative management, oral medications, and advanced procedures like intrathecal drug delivery, where pain medication is delivered directly to the spine.

Supplements like antioxidants and vitamin B complex are some of the go-to treatments people take. These are generally affordable. Oral opioids are usually low-cost too, but not those given into a vein and via a pump. However, current treatments often offer only short-term and modest relief.

To mitigate side effects, doctors may adjust chemotherapy regimens—pausing and restarting treatment, slowing infusions, adjusting how often treatments are given, changing the method of administration, lowering doses, or shortening treatment duration—according to Vega.

A Difficult Choice

Severe nerve pain drives some cancer patients to reduce their chemotherapy dose or stop treatment entirely. According to Vega, the decision to adjust or discontinue chemotherapy is made through shared decision-making, where patients, their oncologist, and the palliative care team weigh the risks and benefits.

However, stopping treatment worsens treatment outcomes and increases cancer-related mortality. For some, CIPN persists for years despite their cancer already being in remission and their last dose of chemo taken years ago. For others, the pain is so unbearable that they decline further treatment and choose quality of life with fewer symptoms from cancer treatments—a devastating choice with no real alternative.

Six years after treatment, Aufdenberg’s hands and mouth are mostly recovered, but she still has pain, numbness, and pins and needles in her feet.

She has since developed Type 2 diabetes, which has exacerbated her neuropathy, and has been working on keeping her diabetes under control.