What Is Chemotherapy-Induced Peripheral Neuropathy?

Chemotherapy works by targeting fast-growing cancer cells. But some of the drugs used can also damage the nerves that run outside the brain and spinal cord. These are called peripheral nerves. When chemotherapy harms these nerves, the condition is called chemotherapy-induced peripheral neuropathy, or CIPN.

For people with colorectal cancer, CIPN is one of the toughest side effects of treatment. The damage tends to affect the nerves farthest from the center of the body. Mainly the hands and feet. According to the National Cancer Institute, nerve problems from cancer treatment can affect how you feel pain, temperature, and touch, and how you move.

For some people, symptoms improve after treatment ends. For others, they can last months or even years. Understanding what causes CIPN and what may help is an important part of managing your care.

Why Does Oxaliplatin Cause Nerve Damage?

The chemotherapy drug most closely linked to neuropathy in colorectal cancer treatment is oxaliplatin. Doctors use this drug in several standard treatments for colon and rectal cancers.

Two distinct forms of oxaliplatin-related nerve damage are described in a review of oxaliplatin-induced neurotoxicity published in the NIH literature:

• Acute neuropathy: This form is very common and usually appears during or shortly after an infusion. It causes sharp sensitivity to cold. Touching a cold surface, drinking a cold liquid, or breathing cool air may trigger sharp pain or discomfort. This form typically fades within a few days after each infusion cycle.
• Chronic neuropathy: This form builds up as you receive more doses of oxaliplatin over time. It causes lasting numbness, tingling, and sometimes pain in the hands and feet. Unlike the acute form, it may not go away quickly after treatment ends.

Oxaliplatin affects the nervous system through several processes. These include damage to the DNA inside nerve cells, disruption of the channels that carry electrical nerve signals, inflammation in nerve tissue, and stress on the tiny structures inside nerve cells called mitochondria. All of these changes make it harder for nerve cells to send signals the way they normally would.

What Does Neuropathy Feel Like?

CIPN can feel different from person to person. Symptoms range from mild and manageable to severe and disruptive. The most common signs include:

• Numbness or a hollow, dead feeling in the hands or feet
• Tingling, often described as pins and needles
• A burning or shooting pain
• Strong sensitivity to cold temperatures — a hallmark of oxaliplatin-related neuropathy
• Weakness in the hands or feet
• Difficulty with fine motor tasks, such as buttoning a shirt, typing, or picking up small objects
• Balance problems or unsteadiness when walking

The American Cancer Society notes that CIPN can affect your ability to walk, write, and carry out everyday tasks. In more severe cases, it may raise the risk of falls or injuries. Tell your care team right away about any new nerve symptoms. Don't wait until your next visit.

Who Is at Greater Risk for CIPN?

Not everyone who receives oxaliplatin develops the same level of neuropathy. Several factors may raise a person's risk:

• Higher total dose of oxaliplatin: Nerve damage from oxaliplatin builds up over time. The more of the drug a person receives across treatment cycles, the greater the chance of developing lasting symptoms.
• Pre-existing nerve problems: If you already have some level of nerve damage (from diabetes, for example), your nerves may be at higher risk from the start of treatment.
• Older age: Older adults often have more severe or longer-lasting neuropathy.
• Other health conditions: Conditions that already affect nerve health or circulation may raise your risk.

A study using data from the SCOT trial in colorectal cancer patients found that people with any neuropathy before chemotherapy had worse CIPN scores during and after treatment. Sharing any pre-existing nerve symptoms with your care team before treatment begins can help them monitor you more closely.

How Long Does Neuropathy Last?

Many people ask whether neuropathy will go away after treatment ends. The answer depends on the individual.

The cold sensitivity tied to each oxaliplatin infusion often eases within a few days. But chronic neuropathy that has built up over multiple treatment cycles may take much longer to change. Some people notice gradual improvement over months or years after treatment. Others may have symptoms that continue for a long time.

The National Cancer Institute notes that the outlook depends on which drug was used, how much you received, and whether other risk factors were present. Your care team is the best source of guidance about what to expect in your specific case.

Ways to Find Relief

Talk to Your Care Team Early

Report any nerve symptoms as soon as they begin. Early communication gives your care team more options. They may be able to adjust your treatment plan, refer you to a specialist, or suggest ways to manage symptoms before they worsen. Keeping a simple diary of when symptoms occur and how intense they feel can help your team make better decisions.

Medicines for Nerve Pain

No single medicine fully prevents or reverses CIPN. However, certain medicines may help reduce pain and improve daily functioning. Some medicines may help reduce nerve pain. Your oncologist or a pain specialist can discuss which options, if any, may be suitable for your situation. Never start or stop any medication without guidance from your care team.

Exercise and Physical Therapy

Physical activity helps manage CIPN. Studies show that structured exercise—including walking, balance training, and strength work—may help reduce numbness and pain.

A review of lifestyle-related factors in colorectal cancer neuropathy management found that physical exercise and other treatments may reduce CIPN symptoms. A physical therapist with experience in oncology care can help design a safe program that fits your current level of energy and function. Starting slowly and building up gradually is usually recommended.

Acupuncture

Some people with CIPN report that acupuncture helps ease their symptoms. Acupuncture involves placing needles at specific points on the body to help reduce pain and nerve discomfort. Some studies show it may help with neuropathy pain and quality of life. Results vary between individuals, and more research is still ongoing. If you are interested, ask your care team if acupuncture might help you.

Keeping Safe at Home

Neuropathy makes it harder to feel pain, heat, or pressure. This means you might not notice cuts or injuries. The American Cancer Society recommends the following steps to help protect yourself:

• Wear shoes that cover your whole foot at all times, even indoors
• Place rubber mats in the bathtub and shower to reduce slipping
• Use handrails on stairs and grab bars near the toilet and tub
• Use night lights when moving around in the dark
• Wear gloves when handling sharp objects or doing household or yard tasks
• Test bath water temperature with your elbow before stepping in, as neuropathy can dull heat sensation in the feet
• Check your feet each day for cuts, sores, or bruises you may not have felt

Managing Cold Sensitivity

If cold sensitivity is a problem during oxaliplatin treatment, small habits can help. Wear gloves when opening the refrigerator or freezer. Drink cold beverages through a straw or let them reach room temperature first. Dress in warm layers when going outside in cooler weather. These steps may reduce discomfort from cold during your treatment.

The Emotional Impact of Living With Neuropathy

Chronic nerve pain and loss of sensation in the hands and feet can affect your whole quality of life. Many people with CIPN feel frustrated and anxious, especially when neuropathy limits activities they once did with ease. Some feel less independent. These feelings are common and completely understandable.

Talking with a counselor, social worker, or psychologist familiar with cancer care can help. Support groups (both in person and online) connect people who understand what it is like to live with lasting neuropathy. If you are supporting a loved one through treatment, our guide on supporting a partner through cancer treatment may offer useful guidance on how to support each other.

When to Talk to Your Doctor

Contact your care team right away if you notice any of the following:

• New or worsening numbness, tingling, or pain in the hands or feet
• Weakness that affects your ability to grip, button, write, or walk safely
• A fall or near-fall due to balance problems
• Difficulty sensing temperature differences, such as hot water or cold surfaces
• Pain that is disrupting sleep or limiting daily activities

Don't downplay neuropathy symptoms, even when they seem minor at first. Your care team is there to help, and early action helps.

This article is for general information and is not a substitute for medical advice. Always consult your oncologist or care team about your specific situation.