Dear Dr. Roach: I have been dealing with neuropathy in both my feet for two years now as a result of the chemotherapy I received to fight breast cancer. I have tried everything, including acupuncture, and am currently on gabapentin, which doesn’t help either. The creams I rub on my feet work for about 20 minutes, which allows me to get to sleep. I find my feet are better whenever I elevate them. But I can’t sit around all day! Is there anything I can do to alleviate the numbness I feel? I have balance issues too and sometimes I have to use a cane. I’m 73 and would love to get back to traveling, but I feel insecure on my feet.
— K.D.
Answer: Although chemotherapy is often effective in fighting cancer, most cancer chemotherapy has side effects, and some, such as the platinum-based chemotherapy often used in breast and other cancers, may cause damage to the peripheral nerves. “Neuropathy” is a term used for any kind of nerve damage, and while sometimes the cause is apparent — neuropathy from diabetes or chemotherapy, as in your case — sometimes there is no apparent cause even after a careful evaluation. I get many letters about unexplained neuropathy.
The literature on chemotherapy-induced neuropathy recommends exercise and physical therapy as first line treatments. This is less to reduce numbness as it is to increase function and reduce fall risk, which help to improve the quality of life. Given your feeling insecure on your feet, physical therapy may be the most important treatment for you. A therapist can also check whether your cane is properly fitted and appropriate.
I have often tried gabapentin (Neurontin) or a similar drug, pregabalin (Lyrica), but have not had much success. Duloxetine (Cymbalta) has evidence showing effectiveness at reducing pain and improving numbness, and those treated with duloxetine had a better quality of life than those on placebo. Finally, a preliminary trial showed a compounded cream containing baclofen, amitriptyline and ketamine showed some benefit.
