Peripheral neuropathy can be a symptom of lymphoma and is a common side-effect of some lymphoma treatments. It is caused by the temporary or permanent damage of the nerves of the peripheral nervous system. This damage can result in altered sensations such as:
- numbness
- pin and needles
- pain
- burning sensations
- changes to sexual sensitivity
- going to the toilet.
This page will concentrate mostly on peripheral neuropathy in general, but if you would like more information on changes to sexuality and intimacy, or bowel changes while having treatment, please click on the links below.
What is our nervous system?
Our nervous system works a bit like a network of electrical wires.
Specialised cells (receptors) and nerves within our nervous system pick up and carry signals (messages) between our brain and different parts of our body. These signals, work continuously and let our body know how to work, and how to understand the world around us, through our senses of taste, smell, sound, touch, balance and our position.
Our nervous system is also responsible for our movement and muscle contraction. It provides information to our heart, lungs, bowels and all our organs to let them know when to contract and relax.
However, if you have peripheral neuropathy, these messages are disrupted, so the sensations in your body may change.
Central nervous and Peripheral nervous system
Our central nervous system involves all our nerves and receptors in our brain, spinal cord and an area behind our eyes. It can receive and send messages to our peripheral nervous system to keep our body working well.
Parasympathetic and Sympathetic System
Our peripheral nervous system is all the other receptors and nerves outside of our central nervous system, that are found right throughout our body. They send and receive messages to and from our brain. we have a parasympathetic and sympathetic nervous system that work together to keep our body movement working.Â
Click on the picture to see how they work together.
Autonomic, Motor and Sensory Nerves
Some parts of our nervous system work automatically, such as those that send signals to our heart, lungs and bowels. This automatic nerve activity is called autonomic.
Other parts of our nervous system we can control, such as when we choose to run, or lift something or have another conscious movement. These nerves that we have control over are called motor nerves.
Our sensory nerves and receptors send and receive messages about temperature and touch. These help us to identify danger if we touch something too hot or cold, or sharp, oh if it puts too much pressure on us.
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What is peripheral neuropathy?
Peripheral neuropathy is a disorder of the receptors and nerves outside of your central nervous system. It occurs when the peripheral receptors or nerves become damaged, and so the messages sent to and from your brain get stopped, or scrambled.
Depending on where the damage is, you may experience any of the below symptoms.
Symptoms of Peripheral Neuropathy according to nervous system | ||
Sensory neuropathy | Motor neuropathy | Autonomic neuropathy |
 Tingling, burning, pins and needles or electric shock feeling in your hands or feet.   Loss of sensation or numbness.  Altered sensation to stimuli. Something feeling hot when it is cold.  Loss of balance when you close your eyes.  Loss of reflexes.  Ringing or buzzing in your ears. |  Painful cramps.  Muscle twitching.  Decreased reflexes.  Muscle weakness.  Unsteady gait when walking.  Inability to do up buttons easily.  Trouble writing.  Restless legs.  Dragging, or unable to lift foot properly when walking.   |  Dizziness.  Bladder changes.  Diarrhoea.  Constipation.  Incontinence (not getting to the toilet in time, or not feeling when you need to go).  Feeling of being full earlier than normal.  Impotence or difficulty reaching orgasm.  Abnormal sweating. |
You must let your doctor and nurses know if you get any of the above symptoms. You may need to have the dose of your medicine such as chemotherapy changed, or may have pressure against nerves from the lymphoma, needing other treatments. These things need to be addressed quickly. In many cases, the peripheral neuropathy can be reversed if treated early enough.
Causes of peripheral neuropathy in lymphoma
You have several risk factors for peripheral neuropathy when you have lymphoma. These can include the lymphoma itself, it’s treatments, or other illnesses you may also have, or develop due to your treatments.
Symptoms of Lymphoma
Not all lymphomas will cause peripheral neuropathy, however you are more likely to get it as symptom of lymphoma if:
- You have Waldenstroms Macroglobulinemia (WM). In WM paraproteins can stick to your nerve cells and cause damage to them.
- Your lymphoma is growing around your nerves and putting pressure on them.
- Your lymphoma is growing around blood vessels that supply blood to your nerves and receptors, preventing blood flow to them.
Side-effect of common treatments
- Radiotherapy
- Surgery or procedures where the nerves or receptors are damaged
- Vinca alkaloids (such as vincristine, vinblastine and vinorelbine) – These medicines are given as part of many chemotherapy protocols such as:Â CHOP, CHEOP, Hyper CVAD, CVP, DA-R-EPOCH, BEACOPP, ChIVPP, IGEV, PVAG
- Platinum based medicines (such as cisplatin, carboplatin, oxaliplatin) – These can be given as part of DHAP, GDP, DDGP, DHAC, ESHAP, ICE, RICE, R-GemOx, HiDAC MATRix
- Brentuximab vedotin – This can be given on it’s own or as part of BvCHP, or with other monoclonal antibodies.
- Velcade
- Thalidomide.
This is not a full list of lymphoma treatments that can cause peripheral neuropathy, and as new medicines become available this list may increase. It is important that you mention any signs of peripheral neuropathy to your doctor and nurses so they can determine the cause and best treatment options for you.
Other conditions or factors that can cause peripheral neuropathy
There are other conditions that can cause peripheral neuropathy. These can include:
- Diabetes
- Low vitamin B12
- Infections such as shingles
- Auto-immune diseases
- Smoking
- Alcoholism.
Help to give up or reduce smoking and drinking
Managing other conditions
If you have diabetes or an autoimmune disorder, it is important to continue your treatments for these. You may need to see several teams of doctors to make sure your lymphoma and other conditions are well controlled.
Infections
Talk to your haematologist or oncologist about your risk of infections and what vaccinations are safe for you to have. In some cases, they may recommend a vaccine for shingles or other types of infections.Â
Live vaccines may not be safe when you are having treatment for lymphoma, so make sure to ask which one you should get.
Treatment
There are some natural and over the counter treatments available to help lessen the symptoms of peripheral neuropathy. In some cases, a change in the dose of your medication may be enough to improve your symptoms.
It is very important that you report symptoms of peripheral neuropathy as soon as they start. The sooner the dose changes happen the more likely your peripheral neuropathy will improve.
Over the counter medicines to help with peripheral neuropathy
- capsaicin cream
- vitamin supplements – such as B vitamins
- dermal patches with lignocaine (also called lidocaine)
- glutamine.
Other natural remedies
Other things you can try that will help lessen the impact of peripheral neuropathy include:
- gentle massage
- exercise to improve blood flow
- physiotherapy
- eat healthyÂ
- keeping warm can help for some people, while others find keeping cool helps.Â
- reduce caffeine such as in coffee and energy drinks. Too much caffeine can affect blood flow and make symptoms worse. Try coffee substitutes such as Dandelion tea or caffeine free green teas.
Foods that may help with nerve regeneration
Fish | Fruit & vegetables | Nuts & Seeds |
Salmon Sardines Mackerel Tuna Cod | Spinach Avocado Black beans Green peas Lentils Soybeans Lion’s mane mushrooms Ginger All fresh fruits | Almonds Walnuts Pumpkin seeds  |
Keep hydrated
Dehydration can make peripheral neuropathy worse, and delay healing. Drink at least 6-8 full tall glasses of water each day. If you do not like water on its own, try adding some lemon or lime juice or cordial to the water.
***If you have been given a fluid restriction by your doctor, stick to that advice and only drink as much as you have been instructed.
Medical treatments
You may need medical treatments to improve the symptoms of peripheral neuropathy.  These can include:
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- amitriptyline, duloxetine, pregabalin or gabapentin. These generally work better for peripheral neuropathy pain than opioids.
- cannabinoids
- intravenous (into your vein) lignocaine (lidocaine)
- cryotherapy
- plasmapheresis (Plasma exchange) only if you have Waldenstroms Macroglobulinemia.
Summary
- Peripheral neuropathy is common side-effect of lymphoma treatments, and can be a symptom of some lymphomas.
- Some peripheral neuropathies can be reversed if caught and managed early, others may be permanent.
- Peripheral neuropathy happens when the receptors (specialised cells) and nerve endings outside of the brain and spinal cord become damaged, or have the blood flow to them restricted.
- Over the counter, natural and medical treatments can all be used to improve the symptoms of peripheral neuropathy.
- Report all symptoms of peripheral neuropathy to your haematologist or oncologist before your next treatment.
- Common symptoms can include changes to sensations in your hands and feet, trouble going to the toilet, changes to sexual function among others listed above.
- Call our patient support line to talk to one of our Lymphoma Care Nurses if you have and questions about peripheral neuropathy. Click the contact us bottom at the bottom of the screen for contact details.
