Issue link: https://www.massageandbodyworkdigital.com/i/230373
BREAKING NEW GROUND CIPN is caused by the administration of neurotoxic (nerve-damaging) chemotherapeutic drugs. With CIPN, the sensory nerves are most often affected. After a mild onset, discomfort increases with each additional chemotherapy dose, usually moving proximal as the pain worsens. The duration of CIPN is usually several months, with peak discomfort at 3–5 months after the final chemotherapy dose. Most symptoms diminish within a year and CIPN is rarely irreversible. The condition is more prevalent in chemotherapy patients who drink alcohol heavily or are severely malnourished. The most serious concern for CIPN patients is that the pain or discomfort can become so severe that the patient may choose to discontinue cancer treatment. Even if the discomfort itself is minimal, it may be the last straw for a patient dealing with a complicated medical journey and other side effects. Oncologists generally take great measures to try to reduce the symptoms of CIPN. PATHOPHYSIOLOGY To better understand these conditions, let's do a quick anatomy review. The two main divisions of the nervous system are the central nervous system, which includes the brain and spinal cord, and the peripheral nervous system (PNS). The PNS includes the nerve fibers that transmit sensory information to the brain (for example, "this cup is hot") and the necessary motor signals back from the brain to the muscles to cause the desired response (quickly putting the cup down). To function properly, these long and fragile nerves must regularly receive generous amounts of carefully regulated nutrients and oxygen, and the body's blood glucose level must remain stable. Clinical studies indicate the efficient functioning of the nerves is directly related to the level of oxygen they regularly receive. When the blood glucose level spikes or remains high, or when chemotherapy severely reduces the ability of peripheral nerves to utilize oxygen, there is a greater risk of DPN and/or CIPN. 84 massage & bodywork january/february 2014 Peripheral neuropathies, starting as innocuous and mildly uncomfortable conditions, can lead to a severe decrease in the patient's quality of life, including potential amputations in the case of diabetic patients. Understanding the seriousness of these conditions is paramount if you are to properly perform the protocol and teach clients how to take care of themselves (see Client Homework, page 88). MEDICAL DIAGNOSIS AND TREATMENT Physicians' diagnostic methods for both DPN and CIPN include simple reporting of the location, duration, and intensity of the sensory or motor disturbance; observance of heel-toe gait; and various tests including electrodiagnostic, muscle strength, pin-prick, cranial nerve, and nerve conduction tests. As a massage therapist, you can assess/observe symptoms, document sensory and motor disturbances, and observe heel-toe gait. Early symptoms of both neuropathies are often treated with physical therapy to address muscle weakness, pain, and the loss of balance, mobility, and strength. Transcutaneous electrical nerve stimulation units are recommended for pain control. Physical therapists also teach patients vigilant skin care, and they can attend to open wounds, should the condition progress. Acupuncture is an effective tool for pain management in both types of neuropathy and psychological counseling can help with quality-of-life issues. Preventive methods for DPN include rigorous blood glucose regulation following a diabetes diagnosis. Good nutrition and regular exercise are paramount, and combinations of B vitamins are often prescribed to reduce earlyonset paresthesia. No preventive measures have yet been identified for CIPN. Common Medications Be aware of medications your client may be taking to alleviate neuropathy, so any potential contraindications and side effects may be considered. A potential benefit of the massage protocol described here is decreasing the client's dependence on medication.