Integrative Approaches for Cancer-Related Neuropathic Pain
by Ilyse Streim, Oncology Massage Therapist
Neuropathic pain is a chronic, often debilitating problem that affects a significant number of cancer patients. Peripheral neuropathy is defined as any injury, inflammation, or degeneration of the peripheral nerve fibers. Both chemotherapy and radiation can cause peripheral neuropathy, although chemotherapy-induced peripheral neuropathy (CIPN) is much more common and usually begins during treatment. Radiation-induced peripheral neuropathy most often occurs years after treatment.
Certain chemotherapy agents can damage nerves leaving the patient with tingling, numbness, a sensation of ‘pins and needles’, or sometimes a stabbing pain in the hands and/or feet. Sensitivity to temperature is also reported. Symptoms typically build over time and worsen with each subsequent dose of chemotherapy. CIPN can gradually fade post-treatment. However, some people experience irreversible damage and cope with persistent pain indefinitely.
CIPN can affect simple daily activities such as getting dressed, holding a glass, or walking. Although other side effects of chemotherapy such as nausea, diarrhea, or heart damage may seem more disabling, the discomfort of peripheral neuropathy can cause great fatigue, emotional distress, and can diminish the overall quality of life.
Integrative care is a synthesis of mainstream cancer care and evidence-based complementary therapies. Complementary approaches include massage therapies, acupuncture, and mind-body techniques. Often a combination of physical therapy, massage and acupuncture, and medication such as steroids, opioids, and anticonvulsants are prescribed for symptom management of CIPN.
There are only a small number of studies that assess the use of complementary therapies to alleviate CIPN. However, anecdotal evidence on the benefits of massage abounds. Touch therapies have helped many patients find short-term relief for CIPN. Also the affected areas have returned to normal more quickly with the use of massage.
As an oncology massage therapist, I am trained to make pressure adjustments for neuropathy. Deep massage is not advised, as clients may not be able to give accurate feedback due to decreased awareness in sensation. If a client has extreme pain, I may use very gentle compression holds on the area, or the pressure used is no more than the amount needed to apply lotion. Gentle, undemanding touch can often increase comfort and diminish pain. Massage helps to stimulate circulation and nourish the peripheral nerves. It helps to reduce muscle and fascial restrictions surrounding nerves, and improves joint mobility of bones of the hands and feet. Manual Lymph Drainage stimulates the pumping of fluid that bathe the peripheral nerves and improves lymphatic flow. Reflexology is a light touch technique for hands and feet that aids in pain reduction.
Because CIPN is one of the most common reasons that patients stop treatment early, therapies such as acupuncture and massage are important complementary adjuncts that can help a patient’s journey through cancer treatment be more comfortable and tolerable.
At Good Samaritan’s Center for Integrative Medicine, Ilyse Streim, LMT, CMLDT, provides Manual Lymph Drainage and Oncology Massage.
Barrie R. Cassileth and Francis J. Keefe, “Integrative and Behavioral Approaches to the Treatment of Cancer-Related Neuropathic Pain”, The Oncologist, May 2010, vol.15, supplement 2 19-23.
https://www.youtube.com/watch?v=W9KfDsiJBOo–Treating Chemotherapy-Induced Peripheral Neuropathy Symptoms—Memorial Sloan Kettering, Jan 2013.
JE Cunningham et al., “Case Report Of A Patient With CIPN Treated With Manual Therapy (Massage)”, Spport Care Cancer, September 2011, no. 9, p.19: 1473-6. This case report led to a pilot study funded by the Massage Therapy Foundation.