What Is Chemotherapy-Induced Peripheral Neuropathy (CIPN)?


Peripheral neuropathy is a medical condition that involves damage to the peripheral nerves. 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. Chemotherapy-induced peripheral neuropathy (CIPN) occurs when peripheral nerves are damaged from chemotherapy. CIPN varies in duration and can develop at any time ― from hours to months — following chemotherapy.


The manifestations of CIPN depend on the type of nerve fibers (sensory or motor) affected. Symptoms also vary in intensity, ranging from mild to severe.

Symptoms of CIPN that affects sensory nerves include, but are not limited to, the following

  • Numbness
  • Pain
  • Unusual skin sensations or paresthesia
  • Balance problems or loss of coordination

Symptoms of CIPN that affects motor nerves include, but are not limited to, the following:

  • Muscle weakness or spasms
  • Problems with balance
  • Issues with fine motor skills

Other general symptoms of CIPN include, but are not limited to, the following:

  • Inability to feel temperature in the affected area
  • Reduced reflexes
  • Jaw pain or problems swallowing
  • Hearing loss
  • Bladder or bowel dysfunction

Severe CIPN may lead to the following symptoms:

  • Changes in blood pressure
  • Changes in heart rate
  • Breathing difficulties
  • Injury due to falls
  • Paralysis
  • Organ failure


There are six classes of chemotherapy drugs that can cause CIPN. These include the following chemotherapy agents:

  • Platinum drugs, such as cisplatin and carboplatin
  • Taxanes, including paclitaxel and docetaxel
  • Epothilones, such as ixabepilone
  • Plant alkaloids, such as vinblastine and vincristine
  • Immunomodulating drugs, including thalidomide and lenalidomide
  • Proteasome inhibitors, such as bortezomib and carfilzomib

Risk factors

The following factors increase the risk of CIPN:

  • Use of higher doses, multiple courses, or the combination of multiple chemotherapy drugs
  • Preexisting autoimmune disease
  • Diabetes
  • Vitamin deficiencies
  • Poor peripheral blood circulation
  • Previous spinal cord injury
  • Infections, such as shingles
  • Preexisting peripheral neuropathy
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