Conventional Medical Treatments for Radiation-Induced Peripheral Neuropathy

What is radiation-induced peripheral neuropathy?
The peripheral nervous system is the communication network that connects the central nervous system (the brain and spinal cord) to every other part of the body. It carries sensations, controls movement, and regulates involuntary bodily functions. Radiation-induced peripheral neuropathy refers to a set of symptoms that occur when peripheral nerves are damaged from radiation therapy. Symptoms of radiation-induced peripheral neuropathy include pain, abnormal skin sensations, muscle weakness, or paralysis.

Treatments
Treatment for radiation-induced peripheral neuropathy typically involves a multimodal approach, including medication, management of comorbid factors, and therapy to manage pain and other symptoms.

Medications
Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anti-seizure medications, antidepressants, and opioids, may be prescribed for pain. In addition, medications may be prescribed for symptomatic relief. Examples include quinine and membrane-stabilizing drugs, such as carbamazepine, to reduce cramps and nerve hyperexcitability. Systemic analgesics, including ketamine or lidocaine via infusion, can be helpful when pain is systemic rather than localized.

Management of comorbid factors
Managing other factors that contribute to the development or progression of peripheral neuropathy reduces the risk that radiation-induced neuropathy will worsen. For example, controlling diabetes or high blood pressure; stopping or limiting alcohol or statin use; avoiding surgery, biopsies, or other localized traumas; and promptly treating acute inflammation to prevent fibrosis may help prevent worsening of radiation-induced peripheral neuropathy.

Physical and occupational therapy
Physical therapy includes exercises that improve flexibility and strength. Stretching exercises, massage, lymphatic massage therapy, and compressive therapy can help release trapped nerves, increase circulation, and improve the flow of lymphatic fluid. Nerve stimulation and cautious use of temperature therapy often reduces pain. Occupational therapy may also help. An occupational therapist can recommend adaptive equipment and techniques to help with everyday tasks.