Painful chemotherapy-induced peripheral neuropathies

Some chemotherapeutic drugs can cause dose-limiting peripheral neuropathies that result in distal sensory loss, dysesthesia, sensitisation and pain. Although symptoms usually regress over time, they continue in a significant number of patients.

The risk of chemotherapy-induced peripheral neuropathy is increased by:

• specific chemotherapeutic drugs (eg vincristine, paclitaxel, docetaxel, cisplatin, thalidomide, lenalidomide, bortezomib)
• specific dosing regimens (eg high cumulative dose or dose intensity)
• concurrent use of other neurotoxic drugs
• the presence of pre-existing neuropathy.

There is little evidence to guide pharmacological management of chemotherapy-induced peripheral neuropathy. Drug regimens commonly used for neuropathic pain may not be effective because of the different mechanisms by which chemotherapy-induced peripheral neuropathy develops. Duloxetine has the strongest data to support its use. The evidence base for other antidepressants, gabapentinoids and opioids, alone or in combination, is variable and generally poor.