Chemotherapy-Induced Peripheral Neuropathy (CIPN)
Cancer treatment is often life-saving and plays a vital role in improving survival and outcomes. However, some treatments can also cause ongoing side effects that affect everyday function and quality of life. Tingling, numbness, burning pain, or changes in balance after chemotherapy may be signs of chemotherapy-induced peripheral neuropathy (CIPN).
CIPN is a common side effect of certain chemotherapy medications and can affect movement, independence, confidence, and participation in daily activities. While symptoms may improve after treatment finishes, some people experience ongoing nerve-related symptoms months or even years after completing chemotherapy.
Understanding CIPN, recognising symptoms early, and accessing appropriate rehabilitation support can help reduce its impact and support recovery throughout cancer survivorship.
What is Chemotherapy-Induced Peripheral Neuropathy (CIPN)?
Chemotherapy-Induced Peripheral Neuropathy (CIPN) is a type of peripheral neuropathy caused by damage to the peripheral nerves as a result of some chemotherapy medications.
The peripheral nervous system includes the nerves outside the brain and spinal cord that help control sensation, movement, and automatic body functions. When these nerves are affected, people can experience symptoms such as:
- Tingling or ‘pins and needles’
- Numbness
- Burning or shooting pain
- Increased sensitivity to touch or temperature
- Muscle weakness
- Changes in balance and coordination
CIPN most commonly affects the hands and feet, although symptoms can sometimes extend further up the limbs. For many people, CIPN can significantly affect daily life, making activities such as walking, exercising, driving, working, or completing fine motor tasks more challenging.
What Causes CIPN?
Several chemotherapy medications are known to increase the risk of peripheral nerve damage. These include:
- Platinum-based chemotherapy drugs such as cisplatin, carboplatin, and oxaliplatin
- Taxanes such as paclitaxel and docetaxel
- Vinca alkaloids such as vincristine
- Proteasome inhibitors such as bortezomib
- Immunomodulatory medications such as thalidomide
CIPN can occur in people treated for many different types of cancer, including:
- Sarcomas
- Breast cancer
- Head and neck cancers
- Bowel cancer
- Lymphoma
- Multiple myeloma
- Other cancers requiring neurotoxic chemotherapy medications
Not everyone receiving these medications will develop neuropathy. The likelihood and severity of symptoms can depend on the chemotherapy medication used, cumulative dose, treatment duration, and individual risk factors.
Symptoms of CIPN
CIPN symptoms commonly begin in the toes or fingertips and can spread upwards in a pattern often described as a ‘stocking and glove’ distribution.
Common symptoms include:
- Tingling or ‘pins and needles’
- Burning or shooting nerve pain
- Numbness or reduced sensation
- Increased sensitivity to touch, pressure, heat, or cold
- Muscle weakness
- Difficulty with balance or coordination
- Reduced awareness of foot position (proprioception)
- Trouble with fine motor skills, such as buttoning clothes or handling small objects
Symptoms can begin during chemotherapy treatment or develop after treatment has finished.
How Common is CIPN?
The prevalence of CIPN varies depending on the chemotherapy medications used, treatment dose, duration of therapy, and individual factors.
Research suggests that:
- CIPN symptoms may occur in approximately 30–70% of people receiving neurotoxic chemotherapy, depending on the treatment regimen and population studied
- Symptoms are often most noticeable shortly after chemotherapy begins or during active treatment
- Around 30–40% of people who experience CIPN continue to have symptoms 12 months or longer after completing chemotherapy
- Some people experience gradual improvement over time, while others may have long-lasting or permanent nerve changes
The severity of symptoms can vary significantly between individuals. Some people may experience mild tingling, while others may develop significant changes affecting walking, balance, and daily activities.
Risk Factors for CIPN
Certain factors may increase the risk of developing CIPN, including:
- Pre-existing neuropathy (such as from diabetes)
- Higher cumulative chemotherapy doses
- Longer treatment duration
- Older age
- Nutritional deficiencies
- Alcohol use
- Genetic factors
- Previous exposure to neurotoxic medications
Your oncology team can monitor symptoms throughout treatment and make adjustments where appropriate to help minimise further nerve damage.
How is CIPN Diagnosed?
There is no single test used to diagnose CIPN. Diagnosis is usually based on a combination of:
- Clinical assessment of symptoms
- Neurological examination
- Discussion about chemotherapy history and treatment exposure
- Patient-reported symptom questionnaires
- Functional assessment of movement, balance, and daily activities
- Nerve conduction studies (in some cases)
Early reporting of symptoms to your healthcare team is important. Identifying changes early may help prevent symptoms from worsening and allows appropriate management strategies to be introduced.
Management Strategies for CIPN
While there is currently no treatment that completely reverses CIPN, a combination of medical support, rehabilitation, and self-management strategies can help reduce symptoms, improve function, and support quality of life.
Medical Management
Your oncology team may adjust chemotherapy dose, timing, or treatment schedules if neuropathy symptoms become significant during treatment. Although medications cannot fully repair nerve damage, some medications may help manage nerve-related pain and discomfort.
Physiotherapy and Rehabilitation
Physiotherapy plays an important role in supporting people experiencing CIPN by addressing the functional effects of nerve changes. Although nerves may take time to recover, targeted rehabilitation can help the body adapt, improve movement strategies, and maintain independence.
A rehabilitation program may focus on:
- Strength and Conditioning – maintaining muscle strength and physical activity levels can help support mobility, endurance, and overall recovery during and after cancer treatment
- Balance and Falls Prevention – reduced sensation in the feet and changes in proprioception can increase falls risk. Balance training and movement strategies can improve confidence and safety
- Mobility and Functional Independence – physiotherapy can help people adapt activities and develop strategies to safely complete daily tasks
- Symptom Management – strategies may include low-level laser therapy, education, pacing techniques, desensitisation approaches, and exercise modifications to help manage symptoms
Practical Strategies for Living with CIPN
Small, consistent strategies can make a meaningful difference when managing CIPN symptoms.
These may include:
- Engaging in regular, gentle exercise to support strength, circulation, and endurance
- Incorporating balance exercises to reduce falls risk
- Wearing supportive, well-fitting footwear
- Checking your feet and hands regularly for cuts, blisters, pressure areas, or injuries
- Keeping the skin clean and moisturised
- Avoiding extreme temperatures and testing water temperature before bathing
- Using gloves when handling hot or cold items
- Removing trip hazards at home
- Using pacing strategies to balance activity and rest
How Hunter Rehab Hub Can Help
At Hunter Rehab Hub, we take an individualised approach to managing chemotherapy-induced peripheral neuropathy, focusing on both symptom management and functional improvement.
Depending on your needs, your rehabilitation plan may include:
- Gentle massage and desensitisation techniques to assist with touch sensitivity
- Individualised exercise programs to improve strength, balance, mobility, and confidence
- Falls prevention strategies and home safety advice
- Guidance on pacing strategies to manage fatigue and symptom flare-ups
- Supportive or compression garment prescription where appropriate
- Low-level laser therapy — a non-invasive, medication-free adjunctive treatment option that can help support symptom management, including tingling, numbness, burning sensations, and nerve-related discomfort
Our goal is to help you optimise function, maintain independence, and improve quality of life throughout cancer treatment recovery and long-term survivorship.
Key Takeaways
Chemotherapy-induced peripheral neuropathy is a common side effect of some chemotherapy medications and can significantly affect movement, sensation, and everyday activities.
While complete prevention and reversal of CIPN are not always possible, early recognition, symptom management, and rehabilitation can help reduce its impact and support recovery.
If you are based in Newcastle, Maitland, Lake Macquarie, or the greater Hunter region, and you are currently undergoing or are recovering from chemotherapy and are experiencing:
- Tingling in your hands or feet
- New or worsening numbness
- Burning or shooting pain
- Difficulty walking or using your hands for daily tasks
- Balance problems or frequent falls
Contact the Hunter Rehab Hub team to discuss an individualised rehabilitation plan designed to help you manage symptoms, optimise function, and maximise your quality of life after cancer treatment.
References
Cancer Council Australia. (2022). Understanding peripheral neuropathy. https://www.cancer.org.au
Cancer Institute NSW. (2023). Managing side effects of cancer treatment. https://www.cancer.nsw.gov.au
eviQ. (2024). Peripheral neuropathy associated with chemotherapy. https://www.eviq.org.au
NSW Health. (2023). Cancer treatment side effects and supportive care resources. https://www.health.nsw.gov.au
Peter MacCallum Cancer Centre. (2023). Peripheral neuropathy (patient information). https://www.petermac.org
Australian Physiotherapy Association. (2021). Cancer rehabilitation and physiotherapy guidance. https://australian.physio
Clinical Oncology Society of Australia. (2020). Position statement on exercise in cancer care. https://www.cosa.org.au
Seretny M, et al. (2014). Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis. Pain, 155(12), 2461–2470. https://doi.org/10.1016/j.pain.2014.07.016
Disclaimer
This content is general in nature and provided for educational purposes only. It is not a substitute for individualised medical advice, diagnosis, or treatment. If you have concerns about your symptoms or health, consult a qualified healthcare professional.
