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Hope For Cancer Patients With Hand And Foot Pain

Tingling, burning, numbness, and aching in the hands and feet are well known side effects of several of the most common drugs used today in treating cancer patients. This condition is known as "Chemotherapy Induced Peripheral Neuropathy", and represents damage to the nerves in the hands and feet as a result of exposure to certain anticancer drugs. Although in some cases the symptoms may resolve, they may also remain permanently, imparting devastating, lasting effects on the cancer survivor. In fact, 100% of patients treated with Taxol reported symptoms of neuropathy, often after the first dose. Furthermore, 60 – 100% of patients given Cisplatin reported residual symptoms in long term studies after treatment. (1)

Hand And Foot Pain

Historically, there has been little to offer these patients in the way of a cure for their newfound troubles. These patients were either shunned away as chronic complainers by their physicians, or treated for pain with long-term high doses of narcotics, anti-seizure, or anti-depressant medications due to a lack of a better solution. The numbness would lead to foot ulcerations, infections, and amputations, as well as loss of balance resulting in injuries due to falls. However, recent surgical advancements offer a new sense of hope for relief of these miserably painful symptoms and for the restoration of normal protective sensation. There are over 100 causes of Peripheral Neuropathy and it effects more than 20 million people in America alone.(NA) Diabetes is the most common culprit, followed more and more closely by Chemotherapy. It has been discovered, first in diabetics and later in chemotherapy patients, that in these cases, chronic nerve compression is among the underlying reasons for the nerve damage and the symptoms that follow. Therefore, it makes sense that decompressing these nerves should result in some restoration of more normal nerve function.

Hand And Foot Pain

As you know, in normal human anatomy nerves pass through tight "tunnels" at different sites within the body. The nerves can be squeezed or choked off in these areas if the tunnel is too tight or the nerve becomes too wide, causing numbness, tingling, and burning in the area. In order to continue functioning properly, a peripheral nerve, or a nerve outside of the brain or spinal cord, must communicate with itself from one end (at the spinal cord) to the other (in the hands and feet). It accomplishes this through what is known as "axoplasmic flow". Also, has been proven that once a peripheral nerve is insulted in any way, that the remainder of the nerve becomes more susceptible to compression. If a nerve is squeezed too tightly in one of these tunnels, axoplasmic flow is disrupted. Furthermore, it is known that damaged peripheral nerves can regenerate, or repair themselves, re-grow and resume normal function if placed in the right environment. . In fact, this is precisely what occurs in the well known carpal tunnel syndrome, for which surgery is performed on a daily basis in the U.S. A simple analogy to what occurs is to imagine an empty water balloon slipped through a wedding ring. If several drops of water were placed in the balloon, that water could pass easily from one end of the balloon to the other. However, as one added more and more water to fill the balloon, you could imagine that the two ends of the balloon would grow big and fat, but there would be a central tight, thin area of balloon where the ring would be constricting it. At this point, all the water on one side of the balloon might not so easily make it to the other side past the ring. If you could cut the ring without popping the balloon, the water inside would once again flow freely from one end of the balloon to the other, and the balloon would resume normal size and shape. Certain chemotherapy drugs affect peripheral nerves by causing swelling of the nerve and/or slowing axoplasmic flow. The overall effect is compression of the nerve, which prevents the transmission of messages to and from the hands and feet. Therefore, numbness, tingling, burning, and pain result. However, it is now known that if this compression is detected early enough, it can be treated. Therefore, a very sophisticated, computerized Pressure Specified Sensory Device is used to painlessly detect subtle sensory changes and evaluate the amount of damage done to the nerve. This is called Quantitative Sensory Testing, and is used in the office before and after treatment to evaluate progress. Conservative and Surgical Treatment options exist and are described below: Anodyne Infrared Light Therapy Monochromatic infrared light has been used since the 1960's in Europe to promote healing of tissues through its ability to cause endothelial cells in blood vessels to release nitric oxide, the most potent endogenous vasodilator. The effect is dilation of capillaries leading to more blood, oxygen, and nutrients to injured areas. Its success in healing nerves was an incidental finding during a study on the use of infrared light therapy to heal chronic wounds in diabetic patients, many of also suffered from Peripheral Neuropathy. Not only did the wounds heal in significantly less time than the control group, but the patients also exhibited an increase in sensation to the previously insensate areas. A multi-center study was then conducted on the effects of Monochromatic Infrared Light therapy specifically on Diabetic Peripheral Neuropathy.(1) Findings showed that 98% of patients' symptoms were reversed after 6 treatments, and 100% after 12 treatments. To date, our results are comparable to the above report, and we plan to publish the first study using the Pressure Specified Sensory Device to document the exact percentage of restoration of sensation. Decompression of Multiple Surgical treatment consists of surgical decompression of the nerves supplying the hands and feet. Research has shown, first in lab rats and later in humans, that surgical decompression of these nerves in patients suffering from chemotherapy induced peripheral neuropathy is successful in allowing the nerve to regenerate.(2,3) In an out patient procedure of approximately one hour, through three small incisions, we are now able to relieve the pressure on the nerves responsible for neuropathy. In many cases, pain relief is immediate, and is noticed in the recovery room. However, normal feeling may return for up to one year after surgery. A recent study showed that % of chemotherapy induced neuropathy patients were successfully relieved of pain and restored of sensation after this procedure. Dr. A. Lee Dellon, MD, professor of neurosurgery and plastic surgery at Johns Hopkins University and founder of The Institute for Peripheral Nerve Surgery, is responsible for the majority of these profound advancements in the diagnosis and treatment of peripheral neuropathy. In order to spread the availability of these techniques nationwide, Dr. Dellon began accepting applications from surgeons to spend time with him in Baltimore learning directly from him in practice. I was fortunate enough to have trained with him in 2002 and have been performing these procedures since that time with great success. Therefore, if you or someone you know suffers from numbness, tingling, burning, aching, or cramping in the hands or feet after being treated with chemotherapy, there is help available.