Understanding Chemo-Induced Peripheral Neuropathy (CIPN)

by Courtney Steele  MScPT
Registered Physiotherapist
updated Mar 2, 2026

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Cancer treatment, while life-saving, often comes with a host of challenging side effects. One of the lesser-known, yet significantly impactful, is Chemo-Induced Peripheral Neuropathy (CIPN). For patients undergoing certain chemotherapy regimens, CIPN can be a frustrating and sometimes debilitating condition that affects the hands and feet.

 

What is CIPN?

Peripheral neuropathy, in general, is damage to the peripheral nerves (the nerves of the extremities, typically the hands and/or feet).

CIPN occurs when chemotherapy drugs damage these nerve endings. There are certain classes of chemotherapy drugs that are known to be “neurotoxic” which puts you at risk of developing this neuropathy. They typically affect both sides of the body equally, often starting in the toes and gradually moving up into the feet, or beginning in the fingertips and moving into the hands. This pattern is sometimes described as a “stocking-and-glove” distribution as with neuropathy it will affect your whole hand or whole foot vs. one part of your hand/foot like it would if there is one particular nerve impacted.

 

Common Symptoms of CIPN

The severity and type of symptoms can vary widely depending on the specific drugs used, the cumulative dose, and individual patient factors. Symptoms can appear shortly after the first treatment, or they may develop months after therapy has concluded.

Sensory Symptoms

Numbness or tingling: Often described as a “pins and needles” sensation.
Pain: Burning, shooting, or electric-shock-like pain.
Hypersensitivity (Allodynia): Pain resulting from stimuli that shouldn’t normally be painful, such as the touch of bedsheets or cold air.
Loss of sensation: Difficulty feeling hot or cold, or a decreased sense of touch.

Motor Symptoms

Weakness: Difficulty with fine motor skills (e.g., buttoning a shirt, picking up coins).
Balance and coordination problems: Increased risk of falls due to instability or difficulty sensing where the feet are placed.
Muscle cramping

 

Which Chemotherapy Drugs Cause CIPN?

While many chemotherapy agents can cause neuropathy, certain classes of drugs are particularly known for it. These include:

• Platinum compounds: Cisplatin, Oxaliplatin, Carboplatin.
• Taxanes: Paclitaxel, Docetaxel.
• Vinca alkaloids: Vincristine, Vinblastine.
• Bortezomib and other proteasome inhibitors.

As a patient you should ask your oncology team about the side-effects of your cancer treatments so you know what you might experience and what treatment  options are available so you can seek treatment early.

 

Managing and Treating CIPN

Unfortunately there aren’t many preventative techniques for CIPN.  However, if you are about to start or are currently undergoing Chemotherapy some evidence suggests that the following can help decrease the likelihood of developing CIPN:

• Keep your hands and feet moving during the treatment if you are receiving a known neurotoxic drug.  This increases circulation bringing new blood to your extremities and helps to decrease the likelihood of neurotoxicity
• Cold – applying ice packs to hands and feet or putting them in ice buckets (so you can keep them moving) has some evidence to suggest this can decrease the amount the drugs can affect these distal areas
• Exercise – keeping active (within your limits as dictated by your Physiotherapists) during the period you are receiving chemo can help.  Your exercise levels matter – see a Physiotherapist to determine what heart rate/intensity you should be working at to be safe and avoid overdoing it.  The intensity and type of exercise you can work at safely changes as you progress through chemotherapy and after treatment. It will depend not only on treatment timeframes but also prior exercise habits/status.

Currently, there is no single cure for CIPN, but there are several strategies for management and symptom relief. Below we will outline treatments/management strategies that are in our scope as Physiotherapists but please know there are often tools your oncology team can implement to help too (i.e. dose modification etc) so be sure to talk to your whole team about options.

 

How physiotherapists can help your CIPN:

• Strength exercises for hands/feet: help with fine motor strength to improve tasks like doing up a button
• Balance re-training/coordination exercises: With neurotoxic chemo drugs our balance will be affected either due to loss of sensation in feet/hands and/or your vestibular nerves being affected (how you know where you are in space) – our Vestibular Physiotherapists are specialized in dealing with this so are pros at this!  Your PT will perform a balance assessment in order to determine the right level to start at, prescribe the right exercises for YOU to help improve balance, sensation and decrease risk of falls and prevent medical decline
• Individualized cardiovascular program/exercises: Regular, moderate exercise can help improve blood flow to the extremities and maintain nerve health.  Your PT will help you to find an exercise and dosage that is right for you.
• Acupuncture: Some evidence suggests it may help alleviate certain symptoms.
• Lifestyle Adjustments: Wearing comfortable, well-fitting shoes; using assistive devices for balance; and modifying the home environment to prevent falls (e.g., removing throw rugs). Our Occupational Therapists are a great resource for this too!
• Sensory Re-training: usage of sensory bins to improve/maintain sensation
• Massage: specific types of foot massage techniques have been shown to help improve circulation and sensation follow along with this VIDEO

 

Living with CIPN

Coping with CIPN requires patience and proactive communication with your medical team.

• Monitor Symptoms: Keep a detailed log of your symptoms—when they start, how intense they are, and what makes them better or worse.
• Prioritize Safety: Because CIPN affects sensation and balance, take extra care to prevent cuts, burns (since you may not feel heat), and falls.
• Advocate for Yourself: If symptoms are significantly impacting your daily life, speak up – there may not be a cure for all side effects of cancer treatment but there are often tools and strategies that can help to decrease the effect on the quality of your life.

 

While CIPN can be a persistent challenge, understanding the condition and actively managing its symptoms is key to maintaining a good quality of life throughout and after cancer treatment.