Neuropathy and Other Neurological Symptoms

Neurological symptoms such as chemotherapy-induced peripheral neuropathy (CIPN) can have substantial impacts on your quality of life and ability to complete cancer treatment. Conventional and complementary therapies can help you manage these symptoms.

Neurological symptoms at a glance

Neurological symptoms can display in several ways:

  • Changes in sensation or function such as pain, tingling, or lack of coordination
  • Muscle-related effects such as weakness or difficulty swallowing
  • Cognitive effects such as memory loss or language impairment
  • Pain-related effects such as headaches, back pain, or pain in hands or feet

Both cancer itself and cancer treatments can cause neurological symptoms and side effects. 

Top practices and therapies for managing neurological symptoms

Therapies and practices we have reviewed

The effects of these practices and therapies are described below on this page. Full details of evidence are on the therapy reviews, accessible through the image links below.

Further therapies

Therapies recommended in clinical practice guidelines but that we haven’t yet reviewed; see belowUse your browser's Back button to return to this location. for guidelines ›

Cold or heat

Hypnosis

Transcutaneous electrical nerve stimulation (TENS)

Other therapies

Yoga has some evidence of benefit. The benefit may be meaningful or even substantial, but our reviews show the evidence so far is preliminary.

On this page

What are neurological symptoms?

Neurological side effects and symptoms affect or interfere with the function of the brain or nerves. Symptoms are often grouped into central nervous system (CNS) effects on the brain and spinal cord and peripheral effects on any other nerves. Both cancer itself and cancer treatments can cause neurological symptoms and side effects.

Cancer’s direct effects include compression to the brain, spine, or peripheral nerves from tumor growth. Fractures in vertebrae in the spine or swelling caused by cancer can also cause compression and pressure on nerves. Tumors within the brain or pressure from swelling can cause seizures.1Giglio P, Gilbert MR. Neurologic complications of cancer and its treatment. Current Oncology Reports. 2010 Jan;12(1):50-9.

Paraneoplastic syndromes are another neurological effect of cancer. “Paraneoplastic syndromes are a group of rare disorders that are triggered by an abnormal immune system response to a cancerous tumor known as a ‘neoplasm.’ Paraneoplastic syndromes are thought to happen when cancer-fighting antibodies or white blood cells (known as T cells) mistakenly attack normal cells in the nervous system.”2Paraneoplastic Syndromes. National Institute of Neurological Disorders and Stroke. April 25, 2022. Viewed May 4, 2022.

The most common side effects of cancer treatments are injury to the brain, spine, and peripheral nerves from radiation and peripheral neuropathy from chemotherapy.3Giglio P, Gilbert MR. Neurologic complications of cancer and its treatment. Current Oncology Reports. 2010 Jan;12(1):50-9. Surgery can also damage nerves.4Cancer.Net. Nervous System Side Effects. American Society of Clinical Oncology. February 2018. Viewed May 4, 2022. Chemotherapy-induced peripheral neuropathy is the most researched neurological effect with regard to complementary therapies.

What are the signs of neurological symptoms? 

Neurological effects can be seen in a range of symptoms.5Overview of Nervous System Disorders. Johns Hopkins Medicine. Viewed May 4, 2022; Cancer.Net. Nervous System Side Effects. American Society of Clinical Oncology. February 2018. Viewed May 4, 2022.

Changes in sensation or physical function

  • Loss of feeling or tingling
  • Loss of sight or blurred or double vision
  • Lack of coordination
  • Muscle rigidity
  • Tremors and seizures
  • Hearing loss and/or a ringing in the ears (tinnitus)
  • Changes in taste and smell
  • Erectile dysfunction

Muscle-related effects

  • Weakness or loss of muscle strength
  • Muscle wasting
  • Slurred speech
  • Constipation
  • Loss of urinary control (incontinence)
  • Difficulty swallowing

Cognitive effects

  • Memory loss
  • Impaired mental ability
  • Language impairment (expression or comprehension)

Pain-related effects

  • Persistent or sudden onset of a headache
  • A headache that changes or is different
  • Back pain which radiates to the feet, toes, or other parts of the body
  • Burning or “electrical shock” sensation radiating from the back or other areas

What may cause or trigger neurological symptoms?

In addition to cancer and cancer treatments as described above, these conditions can also lead to neurological symptoms:6Cancer.Net. Nervous System Side Effects. American Society of Clinical Oncology. February 2018. Viewed May 4, 2022.

  • Infections causing swelling or inflammation of the brain, spinal cord, or inner ear
  • Diabetes
  • Thyroid problems
  • Human immunodeficiency virus (HIV)
  • Stroke
  • Alzheimer’s disease
  • Multiple sclerosis
  • Nutritional deficiencies, such as of some B vitamins

Managing these conditions if you have them, or reducing your risk of them, could help you avoid their additional burden on your nervous system. 

Some medications used during cancer treatment or for other conditions may trigger neurological symptoms. Check the inserts with any prescription medications you use or ask your pharmacist if you have concerns. 

Complementary therapies that we have reviewed that may trigger neurological symptoms:

Risk factors

These conditions and situations increase your risk of neurological symptoms such as peripheral neuropathydamage to the peripheral nerves outside the brain and spinal cord:7Peripheral neuropathy. Mayo Clinic. Viewed May 4, 2022; Seretny M, Currie GL et al. Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis. Pain. 2014 Dec;155(12):2461-2470.

  • Diabetes, especially if your sugar levels are poorly controlled
  • Vitamin deficiencies, particularly B vitamins
  • Infections, such as Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, and HIV
  • Autoimmune diseases, such as rheumatoid arthritis and lupus
  • Kidney, liver or thyroid disorders
  • Exposure to toxic substances such as heavy metals—especially lead and mercury—or organophosphorus compounds common in pesticides
  • Repetitive motion, such as those performed for certain jobs
  • Alcohol misuse
  • Family history of neuropathy
  • Smoking

Personal stories

CancerChoices Senior Clinical Consultant Laura Pole, RN, MSN, OCNS: Janie Brown is an oncology nurse and co-founder of a cancer retreat program and center in Vancouver, British Columbia.

Her story is a treasure trove of helpful information. She describes how her partner with breast cancer and her team made decisions about chemotherapy, wove in useful complementary therapies to prevent and minimize treatment side effects, and created a caring community. The integrative plan staved off usual chemotherapy side effects including peripheral neuropathy.

Why is managing neurological symptoms important?

Regarding peripheral neuropathies, a 2022 review states “Not only do they diminish patients’ quality of life, but they can also affect medical therapy and lead to complications.”8Streckmann F, Balke M et al. Exercise and neuropathy: systematic review with meta-analysis. Sports Med. 2022 May;52(5):1043-1065. Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting side effect—severe acute CIPN may require people to reduce or even stop chemotherapy.9Seretny M, Currie GL et al. Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis. Pain. 2014 Dec;155(12):2461-2470. Less treatment can mean a lower chance of treatment benefits. 

About 30–40% of people treated with neurotoxic chemotherapy will develop CIPN. CIPN can linger for years after treatment is stopped.10Seretny M, Currie GL et al. Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis. Pain. 2014 Dec;155(12):2461-2470. 

Resources

What approaches can help me manage neurological symptoms?

We present many approaches to reducing neurological symptoms and the evidence regarding their effectiveness.

Conventional approaches

Several pharmaceutical treatments are often prescribed for neurological symptoms. Ask your oncology team what may be best for you.

Self-care practices

Eating Well: preliminary evidence

Less neuropathic pain unrelated to cancer among people following a low-fat, plant-based diet
(preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently))

Moving More: good evidence

Better balance, nerve conduction velocity, quality of life, and neuropathy-induced symptoms, and quicker movement initiation among people with peripheral neuropathy participating in exercise interventions
(good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently))

Complementary therapies

Good or modest evidence of benefit

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) indicates a relatively high degree of confidence that the therapy is linked to the outcomes as noted. Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) means several smaller or at least one large study have found the effect described.

Acupuncture: good evidence

Fewer symptoms and pain related to chemotherapy-induced neuropathy among people treated with acupuncture (good evidence)

Recommended in practice guidelines for treating neurological symptoms; see below for guidelines ›

Astragalus: good evidence

Less chemotherapy-induced neurotoxicity among people treated with herbal mixtures containing astragalus (good evidence)

Cannabis and cannabinoids: modest and weak evidence

Lower neuropathic pain scores among people with pain treated with THC/CBD or THC alone (modest evidence)

Relief from unmanageable (refractory) seizures in one person with recurrent glioma treated with CBD
(weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently))

Melatonin: modest evidence

Less neurotoxicity during radio/chemotherapy among people treated with melatonin (modest evidence)

Tai chi or qigong: modest evidence

Less neuropathy among people with cancer practicing qigong (modest evidence)

Therapies with preliminary or weak evidence of benefit for neurological symptoms

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) typically indicates that not much research has been published so far, although the outcomes may be meaningful. Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) may mean that the effects are small or that only very preliminary research has been published.

Yoga Learn moreSee Less

Therapies with no evidence of benefit

Electroacupuncture ›

  • No evidence of benefit for chemotherapy-induced peripheral neuropathy among people treated with acupuncture

Non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) ›

  • No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on chemotherapy-induced peripheral neurotoxicity among people with stomach cancer treated with celecoxib in a preliminary study

Further therapies used to manage neurological symptoms

These therapies are used to manage neurological symptoms, but we have not yet reviewed their effectiveness or safety. Those in bold are recommended in at least one clinical practice guideline; see below for guidelines ›

Alpha lipoic acid

Calcium and magnesium

Capsaicin

Cold or heat

Cryotherapy, using frozen gloves and socks on hands and feet

Cysteine and theanine 

Glutamine and glutamic acid

Glutathione

Hypnosis

L-carnosine

L-glutamine

Low-level laser therapy

Massage

Meditation

Menthol

N-acetyl cysteine

Omega-3 fatty acids › 

Transcutaneous electrical nerve stimulation (TENS)

Vitamin B12 (methylcobalamin) 

Vitamin B complex

Vitamin D ›

Vitamin E

Further therapies NOT recommended

Acetyl-L-carnitine: contraindicated for use with paclitaxel due to worsening of chemotherapy-induced peripheral neuropathy (CIPN)

Goshajinkigan: increased CIPN from treatment in one study

Vitamin B6: reduced neurotoxicity when used for preventing cisplatin-include CIPN, but also decreased response duration

Resources

How do integrative experts manage neurological symptoms?

Both medical groups and integrative experts provide recommendations for managing neurological symptoms. Learn more about the approaches and meanings of recommendations.

Clinical practice guidelines

Recommends acupuncture as an adjunct therapy for treating peripheral neuropathy (weak recommendation)

Strongly recommend against use of acetyl-l-carnitine for the prevention of CIPN in people with cancer

Several further therapies are listed as having insufficient evidence for recommending use for treating CIPN. See the list in Are you a health professional? ›

These practices and therapies are listed for treating neuropathic pain:

Sharing Love and Support (psychosocial support)

Acupuncture

Cold or heat

Hypnosis

Transcutaneous electrical nerve stimulation (TENS)

Society for Integrative Oncology

Two guidelines discuss managing neuropathy among people with cancer.

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment › This set of guidelines has been endorsed by the American Society of Clinical Oncology (ASCO).11Lyman GH, Greenlee H et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. Journal of Clinical Oncology. 2018 Sep 1;36(25):2647-2655.

These guidelines recommend against using acetyl-L-carnitine: “should not be recommended for prevention of neuropathy in breast cancer patients due to harm.”

These therapies were reviewed, but were judged to have insufficient evidence to recommend for treating neuropathy:

Acupuncture

Omega-3 fatty acids

Vitamin E

Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals ›

A trial of acupuncture may be helpful for treating chemotherapy-induced neuropathy (weak recommendation).

Integrative programs and protocols

These protocols, programs, and approaches by leaders in integrative cancer care provide guidance for managing neurological symptoms.

We do not recommend specific integrative protocols or programs but provide information for you to evaluate with your healthcare team.

Lise Alschuler, ND, FABNO, and Karolyn Gazella

Approaches are described for certain cancer types, or along with certain conventional therapy treatments, or for particular conditions including neuropathy.

Keith Block, MD

Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009.

The integrative Block Program has recommendations to people who are at different places along the cancer continuum:

  • Those who’ve been recently diagnosed
  • Those in treatment
  • Those who’ve concluded treatment and need to remain vigilant to prevent recurrence

Gerald M. Lemole, MD; Pallav K. Mehta, MD; and Dwight L. McKee, MD

Lemole GM, Mehta PK, McKee DL. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.

These doctors present easy-to-incorporate lifestyle changes to help you “turn on” hundreds of genes that fight cancer, and “turn off” the ones that encourage cancer, while recommending lifestyle approaches to address each type.

Neil McKinney, BSc, ND

McKinney N. Naturopathic Oncology, Fourth Edition. Victoria, BC, Canada: Liaison Press. 2020.

This book includes descriptions and uses of many natural and complementary protocols for cancer in general and for specific cancers. It also includes information on integrative support during conventional cancer treatment.

Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO

Parmar G, Kaczor T. Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition. Medicatrix Holdings Ltd. 2020.

This book provides information on the treatment of 24 cancers, plus the most effective treatments of the most common symptoms affecting cancer patients while they undergo chemotherapy, radiotherapy, or surgery.

Traditional medicine

Practitioners of Ayurveda and traditional Chinese medicine offer therapies and approaches to manage neurological symptoms.

Learn more about traditional medicine and how to find practitioners.

Explore other side effects and symptoms

Are you a health professional?

This section does not replicate the other information on this page but provides additional details or context most relevant to professionals.

Practice guidelines for professionals

Clinicians should not offer, and should discourage use of, acetyl-l-carnitine for the prevention of CIPN in patients with cancer (type of recommendation: evidence based, harms outweigh benefits; Evidence quality: high; Strength of recommendation: strong).

Clinicians should not offer the following agents for the prevention of CIPN to patients with cancer undergoing treatment with neurotoxic agents (type of recommendation: evidence based, no benefits; Evidence quality: intermediate; Strength of recommendation: moderate):

  • All-trans retinoic acid
  • Amifostine
  • Amitriptyline
  • Calcium magnesium
  • Calmangafodipir
  • Cannabinoids
  • Carbamazepine
  • l-carnosine
  • Diethyldithiocarbamate (DDTC)
  • Gabapentin/pregabalin
  • Glutamate
  • Glutathione (GSH) for patients receiving paclitaxel/carboplatin chemotherapy
  • Goshajinkigan (GJG)
  • Metformin
  • Minocycline
  • N-acetylcysteine
  • Nimodipine
  • Omega-3 fatty acids
  • Org 2766
  • Oxcarbazepine
  • Recombinant human leukemia inhibitory factor
  • Venlafaxine
  • Vitamin B
  • Vitamin E

Professional resources

Staff NP, Grisold A, Grisold W, Windebank AJ. Chemotherapy-induced peripheral neuropathy: a current review. Annals of Neurology. 2017 Jun;81(6):772-781.

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Authors

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Reviewer

Sarah Soles, ND

Naturopathic physician
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Dr. Sarah Soles completed her naturopathic medical training at the Canadian College of Naturopathic Medicine. During her internship on the adjunctive cancer care shift, she learned the immense value of combining naturopathic approaches with conventional cancer treatments. Dr. Soles went on to complete a two-year residency in naturopathic cancer care at the Integrated Health Clinic. She continues to help patients in all stages of their cancer journey—from screening and prevention to active treatment or maintaining a remission. She is also the research director for the Knowledge in Naturopathic Oncology Website and a contributing author to the Textbook of Naturopathic Oncology: A Desktop Guide to Integrative Cancer Care.

Sarah Soles, ND Naturopathic physician

Last update: August 1, 2022

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care, and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocialtherapy, and acupuncture therapies and self carelifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

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