Understanding Chemotherapy-Induced Peripheral Neuropathy (CIPN): How Cryotherapy Can Prevent It

Chemotherapy, while an effective cancer treatment option, it can come with a range of challenging side effects. One of the most common and impactful of these is chemotherapy-induced peripheral neuropathy (CIPN), a type of nerve damage that causes numbness, pain, tingling and weakness, most often in the hands and feet. CIPN affects daily life, from simple tasks like walking, dressing, and preparing food often negatively impacting long-term quality of life outcomes. [1]

In this post, we’ll explain what peripheral neuropathy is, why it happens during cancer treatment, and how cryotherapy (a targeted cooling technique) can help prevent it by reducing nerve exposure to toxic chemotherapy agents. We’ll break down the evidence for this approach and what it could mean for people receiving treatment here in Australia and beyond.

What Is Peripheral Neuropathy?

Peripheral neuropathy refers to damage to the most distant and smallest, mostly sensory, nerves in the network of nerves that runs outside the brain and spinal cord and carries signals between the brain and the rest of your body. These nerves communicate sensations like touch, temperature and pain, whereas the motor nerves control movement in muscles. When these small nerves are damaged, the signals can become disrupted, leading to symptoms such as:

• Numbness and tingling in the hands and feet
• “Pins and needles” sensations
• Pain, burning or hypersensitivity
• Balance difficulties and muscle weakness
• Reduced ability to feel temperature changes[2]

Ideally, prevention is a better option; the old maxim of “an ounce of prevention is worth a pound of cure” is certainly true in the case of CIPN. Peripheral nerves may or may not regenerate easily once damaged, which makes preventing injury especially important during chemotherapy. [3]

Understanding CIPN and Its Causes

Chemotherapy-induced peripheral neuropathy (CIPN) is specifically nerve damage caused by certain chemotherapy drugs. Damage can be done to cellular structures including mitochondria, cause microtubule disruption, oxidative stress, and ion channel dysfunction, leading to axonal degeneration, particularly in long sensory nerves. Regeneration is possible to some extent and involves stopping the neurotoxic agent, allowing nerves to slowly repair through axonal regrowth, though 30-40% of patients experience chronic, long-term symptoms.

CIPN can develop during treatment and, for some people, may continue or even worsen after chemotherapy finishes. In fact, up to around 70% of patients receiving high-risk chemotherapy may experience neuropathy symptoms one to many months after treatment, and about 30% still have symptoms six months later. [4] This is called a "Coasting" Phenomenon occurs where symptoms can worsen for 3–6 months after stopping certain drugs (like oxaliplatin) as damage continues after infusions have ended. Initial reports of peripheral nerve sensations from these patients are minimal, only to have them return to the pain clinic months later with worsening symptoms.

These symptoms significantly impact quality of life and can even lead to dose reductions or delays in lifesaving chemotherapy which is why strategies to prevent or reduce CIPN are critical.

What Is Cryotherapy?

Cryotherapy refers to the use of cold temperatures to achieve a clinical benefit. In the context of cancer treatment, it involves applying frozen gloves, socks or cold packs to the hands and feet during chemotherapy infusions. The aim is not to treat existing nerve damage, but to prevent or reduce the severity of CIPN by reducing blood flow to those areas while the chemotherapy drugs are circulating in the body.[5]

This technique is based on the principle that cooling tissues causes the narrowing of blood vessels, which reduces how much chemotherapy reaches the cooled extremities. By limiting exposure of the peripheral nerves, cryotherapy may help protect nerve fibres from damage.[6]

Cryotherapy is used in clinical settings by starting cold application, typically with pre-chilled gloves or socks. For an average treatment during chemotherapy of 90 minutes it is recommended that a minimum of two (2) pairs of IceCold Gel Gloves and Socks be used alternating between each pair. Each pair lasting approximately 30-40 minutes. Where a freezer is not readily available a third of fourth pair may be required.[7]

You can check out Aurora Directs IceCold range here  https://auroradirect.com.au/collections/ice-cold?srsltid=AfmBOoqeU6kfdsXWyGUf3ioFmtzVIitn2vAwhzI9nwwrxMGeWe-aq_J3

How Cryotherapy Works to Reduce Nerve Damage

The central theory behind cryotherapy’s protective effect is local vasoconstriction: cooling causes small blood vessels (capillaries) in the hands and feet to constrict, reducing blood flow and thus lowering the amount of chemotherapy that reaches nerve endings in those areas. This can potentially lower the risk that the nerve fibres are exposed to the toxic effects of the treatment. [8]

Evidence suggests that cryotherapy can significantly reduce the incidence of CIPN. For example, studies report reductions in the risk of CIPN development when cooling is applied during chemotherapy, and that cryotherapy improves subjective symptoms and quality of life scores compared with standard care.[9]

If you or someone you care for is starting chemotherapy with drugs known to cause peripheral neuropathy, it’s worth discussing cryotherapy and other preventative options with your cancer care team to see what might be appropriate in your situation. If you are unsure which drugs are prescribed and if they may cause CIPN, again, discuss with your cancer care team to help develop a prevention strategy.  Check out our full range of IceCold packs here.