Peripheral neuropathy (damage to the peripheral nerves) is a common side effect of chemotherapy and certain other cancer treatments.

What is chemo-induced peripheral neuropathy?

Chemotherapy-induced peripheral neuropathy (CIPN) is nerve damage resulting from certain cancer treatments. Peripheral neuropathy refers to damage to the peripheral nervous system, the network of nerves that sends signals between the brain and spinal cord and the rest of the body. These nerves help control sensation, movement and automatic body functions. Damage to the peripheral nerves can disrupt how the body senses touch, temperature and pain and how muscles move. CIPN may develop during treatment or after chemotherapy has ended. In some people, symptoms persist for months or years after treatment.

Symptoms do not always improve immediately after chemotherapy stops. With some chemotherapy drugs, especially platinum agents such as oxaliplatin and cisplatin, neuropathy may continue to worsen for several months after treatment has ended before stabilizing. This phenomenon, known as “coasting,” is well recognized and does not necessarily mean the cancer is returning.

Types and Symptoms of Chemo-Induced Peripheral Neuropathy

CIPN may affect different types of nerves, which determines the symptoms:

• Sensory nerves: Control touch, temperature and pain. Sensory symptoms include:
  • Tingling or “pins and needles” sensation.
  • Numbness or reduced ability to feel.
  • Burning, sharp or shooting pain.
  • Increased sensitivity to touch or temperature, such as sensitivity to cold.
• Motor nerves: Control muscle movement. Motor symptoms include:
  • Muscle weakness, especially in the hands and feet.
  • Difficulty walking, maintaining balance or coordinating movements.
  • Trouble with fine motor tasks (such as buttoning clothing).
• Autonomic nerves: Control organs and body functions. These nerves are less likely to be affected by CIPN; symptoms depend on which organs and systems are affected:
  • Heart and vascular system: dizziness and fainting
  • Gastrointestinal organs: constipation, diarrhea and problems with digestion
  • Urinary tract: trouble emptying the bladder or incontinence (leakage)
  • Problems with sweating and temperature regulation

Symptoms often begin in the toes and fingers and may spread upward in a “glove-and-stocking” pattern.

What causes CIPN?

Peripheral neuropathy is typically associated with specific chemotherapy drugs:

• Platinum-based drugs (such as cisplatin and oxaliplatin)
• Taxanes (such as paclitaxel and docetaxel)
• Vinca alkaloids (such as vincristine)

Most chemotherapy agents cause a shared pattern of CIPN, usually the “glove-and-stocking” sensory neuropathy (numbness, tingling and pain in hands/feet). However, each drug class also has distinct features and patterns.

Certain other cancer drugs that are not considered traditional chemotherapy may also cause peripheral neuropathy. They include:

• Cancer-specific therapies (such as proteasome inhibitors (e.g. bortezomib) for multiple myeloma).
• Immunomodulation drugs (such as thalidomide and lenalidomide).
• Antibody drugs (such as brentuximab vedotin and trastuzumab emtansine) .
• Immune checkpoint inhibitors (such as nivolumab, pembrolizumab and ipilimumab).
• Other cancer-related drugs.

Researchers continue to study why some people develop severe neuropathy while others receiving the same treatment develop few or no symptoms. Genetic, metabolic and immune factors are believed to contribute to a person’s susceptibility.

Who is at risk of developing peripheral neuropathy during or after chemo?

Not everyone who undergoes chemotherapy with these drugs develops peripheral neuropathy. However, the risk increases with:

• Higher drug doses.
• Longer treatment duration.
• Combination of multiple cancer drugs.

Other individual factors may also increase the risk of developing CIPN. They include:

• Older age.
• Certain pre-existing conditions such as diabetes, HIV, vitamin deficiencies and previous nerve damage.
• Lifestyle habits, such as excess alcohol and smoking.
• Higher BMI.

Certain medical conditions and medications may influence the risk or severity of neuropathy in some patients.

Can chemotherapy-induced peripheral neuropathy be prevented?

Although researchers have identified risk factors, there is currently no medication or intervention that has been proven to reliably prevent chemotherapy-induced peripheral neuropathy in routine clinical practice. However, prevention remains an active area of research, with investigators studying new strategies to protect nerves during cancer treatment. It is important to recognize symptoms early and discuss options with your oncology team. Adjustments to cancer therapy may help reduce the severity of nerve injury in some people.

How is CIPN diagnosed?

CIPN diagnosis is based mainly on:

• Medical history, including chemotherapy exposure and other cancer treatments.
• Assessment of symptoms, including numbness, tingling, weakness, balance problems and pain.
• Physical and neurological examination to evaluate sensation, strength, reflexes and coordination.

Your doctor will also consider the type of cancer treatment you received, the timing of your symptoms and whether another condition could be contributing to neuropathy. Additional testing may be recommended for some people, especially if the diagnosis is uncertain or another cause of neuropathy is suspected. These tests may include:

• Blood tests to evaluate for other causes of peripheral neuropathy, such as diabetes or vitamin deficiencies.
• Nerve conduction studies and electromyography.
• Skin biopsy to evaluate small-fiber neuropathy in some patients.

How is CIPN treated?

Currently, there is no treatment that can reliably reverse nerve damage caused by chemotherapy. Recovery varies from person to person. Mild neuropathy may gradually improve over months, while more severe nerve injury can persist for years or become permanent.

Some people mainly experience numbness and loss of sensation, while others develop burning, electric or stabbing nerve pain. These symptoms can occur separately or together, and may need different treatment approaches. Even when numbness remains, pain may improve over time with appropriate treatment and rehabilitation.

Treatment focuses on relieving symptoms, improving function and preventing further nerve injury. The treatment plan may include a mix of strategies:

• Cancer treatment adjustments: Decisions about modifying chemotherapy should be made with your oncology team, balancing the benefits of cancer treatment against the severity of neuropathy. Options may include:
  • Reducing the dose of chemotherapy.
  • Changing to a different drug.
  • Delaying or stopping the drug if symptoms are severe.
• Medications for symptom relief
  • Antidepressants (such as duloxetine) help modify how the brain and spinal cord process pain signals.
  • Anti-seizure medications (such as gabapentin or pregabalin) may help relieve nerve pain in some patients. However, the data supporting that these medications help with CIPN symptoms is less consistent than for duloxetine.
  • Pain relievers can target a specific area or the entire body.
• Rehabilitation therapies
  • Physical therapy to improve balance, strength, gait and reduce fall risk
  • Occupational therapy to help with the activities of daily living, including safety strategies to prevent falls and injuries
• Lifestyle and supportive care
  • Exercising regularly, as tolerated
  • Following good sleep habits
  • Managing diabetes and other medical conditions
  • Avoiding excess alcohol
  • Protecting numb hands and feet from injury

Research continues to improve our understanding of CIPN and identify new approaches for preventing and treating nerve injury.

Neuromodulation for CIPN

People with severe chronic pain that has not responded to medications and rehabilitation may consider neuromodulation. These advanced therapies use mild electrical stimulation to modify pain signals traveling through the nervous system and may improve pain and quality of life in carefully selected patients.

Neuromodulation options for CIPN:

• Spinal cord stimulation
• Peripheral nerve stimulation
• Dorsal root ganglion stimulation
• Transcutaneous electrical nerve stimulation (TENS), including scrambler therapy

When should I see a pain specialist?

People who experience persistent symptoms despite standard treatments may benefit from evaluation at a specialized pain center. Such centers may offer comprehensive assessment, rehabilitation, advanced pain management techniques and neuromodulation therapies. Consider an evaluation by a pain specialist if:

• Pain continues despite standard medications.
• Symptoms interfere with walking, sleep or daily activities.
• Chemotherapy must be reduced or stopped because of neuropathy.
• Symptoms persist months after treatment ends.
• You would like to discuss advanced treatment options or participate in clinical research.

Living with CIPN

Chemotherapy-induced peripheral neuropathy can significantly affect quality of life and may persist after the chemotherapy treatment ends. While some people regain normal nerve function, others experience persistent or permanent symptoms, especially after more severe nerve injury.

Because CIPN often reduces sensation, especially in the hands and feet, injury risk is higher for people with peripheral neuropathy.

Preventing Falls

• Use handrails on stairs and in bathrooms.
• Keep floors clear of clutter, cords or rugs.
• Wear supportive, well-fitting shoes.

Protecting Hands and Feet

• Check skin daily for cuts, burns or sores.
• Use gloves when cooking or handling hot items.
• Test water temperature before bathing.

Emotional and Mental Health

Living with chronic symptoms can affect mood and mental well-being. Certain support strategies can help, including:

• Counseling or support groups.
• Mind–body techniques (e.g., mindfulness, relaxation).
• Open communication with your care team.

Researchers continue to develop new treatments for chemotherapy-induced peripheral neuropathy. Laboratory and translational research are improving our understanding of how chemotherapy damages peripheral nerves, and may lead to future therapies that prevent nerve injury or promote nerve repair.

Medically reviewed by Eellan Sivanesan, M.D., July 24, 2026.