Chemotherapy-Induced Peripheral Neuropathy (CIPN): Difference between revisions
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== Risk Factors == | == Risk Factors == | ||
[[Genetics and Health|genetic]] susceptibility, age, any existing nerve damage, severity of acute symptom, [[Alcoholism|chronic alcohol consumption]].<ref name=":0" /> | |||
===== Chemotherapy Agents ===== | |||
The prescribing oncologist selects chemotherapy treatments that they deem to be most appropriate for each patient's diagnosis, prognosis, etc. However, the type, cumulative dose, number of treatment cycles (and their duration) of the selected chemotherapeutic agent can increase the risk for developing CIPN. <ref name=":0" /> The following drugs appear to have the highest prevalence rates of CIPN development: <ref name=":2">Zajączkowska R, Kocot-Kępska M, Leppert W, Wrzosek A, Mika J, Wordliczek J. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471666/ Mechanisms of Chemotherapy-Induced Peripheral Neuropathy.] Int J Mol Sci. 2019 Mar 22;20(6):1451.</ref> | |||
* platinum-based drugs(70-100% CIPN prevalence rate) | |||
* taxanes (11-87%) | |||
* ixabepilone (60-65%) | |||
* thalidomide and analogues (20-60%) | |||
Bortezomib (a proteasome inhibitor) and vinca alkaloids are also associated with developing CIPN, but to a lesser degree. <ref name=":2" /> | |||
== Pathomechanisms == | |||
The respective pathomechanics for a respective chemotherapeutic agent is dependent on its class and are often multifactorial. However, these mechanisms involve microtubule destruction, immunological processes, neuroinflammation, oxidative stress, mitochondrial damage, alterations in ion channel activity, damage to the myelin sheath, and damage to DNA. <ref name=":2" /> | |||
== Treatment == | == Treatment == | ||
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== Physiotherapy == | == Physiotherapy == | ||
Physiotherapy is an important therapy intervention for people with neuropathies. Through individualised treatment plans and interventions, it aims to improve movement and relieve pain and discomfort. Also these clients are at increased risk of falls and home safety evaluations and assistive device may be needed<ref name=":1" />. The scope of these interventions ranges from strengthening exercises designed to address muscle weakness, to balance exercises that address fall risks. For more see [[Neuropathies|here]] | Physiotherapy is an important therapy intervention for people with neuropathies. Through individualised treatment plans and interventions, it aims to improve movement and relieve pain and discomfort. Also these clients are at increased risk of falls and home safety evaluations and assistive device may be needed<ref name=":1" />. The scope of these interventions ranges from strengthening exercises designed to address muscle weakness, to balance exercises that address fall risks. For more see [[Neuropathies|here]] | ||
== Differential Diagnosis == | |||
* [[Diabetic Neuropathy]] | |||
** Common differences: | |||
== References == | == References == | ||
Revision as of 23:00, 30 March 2024
Original Editor - Lucinda hampton
Top Contributors - Lucinda hampton and Mason Trauger
Introduction[edit | edit source]
Chemotherapy-induced peripheral neuropathy (CIPN) commonly occurs as an adverse event following chemotherapy.
- Typically presents as: Pain, burning, tingling, and loss of sensation in the distal extremities that spread from the hands and feet.
- Typically spreads in a “stocking-glove pattern”
- Causative agents include platinum-based medications (e.g., cisplatin), taxanes (e.g., paclitaxel), and vinca alkaloids (e.g., vincristine).[1]
CIPN can have an effect on the sensory, motor and/or autonomic nerves[2].
Currently there is no gold standard for diagnosis, no proven ways to lessen or stop this condition and treatment strategies are limited.[2]
CIPN regularly impacts chemotherapy, occasionally requiring the dose to be reduced or treatment ceased, effecting survival rates. Around 30% of patients will still have CIPN a year or more post chemotherapy[3].
Physiotherapy, in the form of exercise therapy, has been shown to have a role in reducing symptoms in CIPN[4].
Risk Factors[edit | edit source]
genetic susceptibility, age, any existing nerve damage, severity of acute symptom, chronic alcohol consumption.[2]
Chemotherapy Agents[edit | edit source]
The prescribing oncologist selects chemotherapy treatments that they deem to be most appropriate for each patient's diagnosis, prognosis, etc. However, the type, cumulative dose, number of treatment cycles (and their duration) of the selected chemotherapeutic agent can increase the risk for developing CIPN. [2] The following drugs appear to have the highest prevalence rates of CIPN development: [5]
- platinum-based drugs(70-100% CIPN prevalence rate)
- taxanes (11-87%)
- ixabepilone (60-65%)
- thalidomide and analogues (20-60%)
Bortezomib (a proteasome inhibitor) and vinca alkaloids are also associated with developing CIPN, but to a lesser degree. [5]
Pathomechanisms[edit | edit source]
The respective pathomechanics for a respective chemotherapeutic agent is dependent on its class and are often multifactorial. However, these mechanisms involve microtubule destruction, immunological processes, neuroinflammation, oxidative stress, mitochondrial damage, alterations in ion channel activity, damage to the myelin sheath, and damage to DNA. [5]
Treatment[edit | edit source]
Pharmacological: Pharmacological treatment for peripheral neuropathic pain is not very effective and also may have serious harmful consequences[6]. Treatment option for symptoms include:
- Steroids, to lessen inflammation
- Topical anesthetics
- Antiseizure medications, which can help relieve nerve pain
- Opioids
- Antidepressants
Non pharmacological:
- Transcutaneous electrical nerve stimulation
- Physiotherapy
- Occupational therapy. eg home safety evaluations, assistive devices.[7]
Note. Recently published American Society of Clinical Oncology (ASCO) guidelines
- Suggest strongly that duloxetine (a serotonin–norepinephrine reuptake inhibitor) is the only currently recommended treatment.
- No recommendations for treatment of CIPN in regards to exercise therapy, acupuncture, scrambler therapy, gabapentin, pregabalin, topical gel treatment (containing baclofen/amitriptyline plus/minus ketamine), tricyclic antidepressants or oral cannabinoids.[2]
Physiotherapy[edit | edit source]
Physiotherapy is an important therapy intervention for people with neuropathies. Through individualised treatment plans and interventions, it aims to improve movement and relieve pain and discomfort. Also these clients are at increased risk of falls and home safety evaluations and assistive device may be needed[7]. The scope of these interventions ranges from strengthening exercises designed to address muscle weakness, to balance exercises that address fall risks. For more see here
Differential Diagnosis[edit | edit source]
- Diabetic Neuropathy
- Common differences:
References[edit | edit source]
- ↑ Amboss Chemotherapy Available from:https://www.amboss.com/us/knowledge/Chemotherapeutic_agents (last accessed 24.8.2020)
- ↑ 2.0 2.1 2.2 2.3 2.4 Burgess J, Ferdousi M, Gosal D, Boon C, Matsumoto K, Marshall A, Mak T, Marshall A, Frank B, Malik RA, Alam U. Chemotherapy-induced peripheral neuropathy: epidemiology, pathomechanisms and treatment. Oncology and therapy. 2021 Dec 1:1-66.Available:https://pubmed.ncbi.nlm.nih.gov/33490836/ (accessed 18.8.2023)
- ↑ Colvin LA. Chemotherapy-induced peripheral neuropathy (CIPN): where are we now?. Pain. 2019 May;160(Suppl 1):S1.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499732/ (accessed 19.8.2023)
- ↑ Jesson T, Runge N, Schmid AB. Physiotherapy for people with painful peripheral neuropathies: a narrative review of its efficacy and safety. Pain Reports. 2020 Sep;5(5).Available: https://pubmed.ncbi.nlm.nih.gov/33490836/(accessed 18.8.2023)
- ↑ 5.0 5.1 5.2 Zajączkowska R, Kocot-Kępska M, Leppert W, Wrzosek A, Mika J, Wordliczek J. Mechanisms of Chemotherapy-Induced Peripheral Neuropathy. Int J Mol Sci. 2019 Mar 22;20(6):1451.
- ↑ Jesson T, Runge N, Schmid AB. Physiotherapy for people with painful peripheral neuropathies: a narrative review of its efficacy and safety. Pain Reports. 2020 Sep;5(5).Available:https://pubmed.ncbi.nlm.nih.gov/33490836/ (accessed 19.8.2023)
- ↑ 7.0 7.1 Wasilewski A, Mohile N. Meet the expert: How I treat chemotherapy-induced peripheral neuropathy. Journal of Geriatric Oncology. 2021 Jan 1;12(1):1-5.Available:https://pubmed.ncbi.nlm.nih.gov/32561202/ (accessed 22.8.2023)
