Neuropathy
Learn how colorectal cancer treatments can cause neuropathy — tingling, numbness, or pain in the hands and feet — and find practical strategies to manage symptoms.
Any of the body’s nerve systems—motor, autonomic, and sensory—can be impacted by chemotherapy and result in peripheral neuropathy. While anyone taking chemotherapy containing platinum may experience CIPN, there are some risk factors that may predispose you to neuropathy, such as:
- Older age
- Previous neuropath or diabetes
- Smoking
- Experiencing sensory changes during chemotherapy
What causes CIPN?
FOLFOX and CapeOX are first-line treatments for stage III colorectal cancer patients, and oxaliplatin is part of both regimens. Oxaliplatin can cause toxicity of the nerves. Neuropathy depends on how much chemotherapy you receive, and for how long. The higher the dose, and the longer you receive treatment, the worse neuropathy can become.
“It feels like ants are crawling on your skin. You may feel like you’ve got hair stuck somewhere, you just keep rubbing it off, but there’s really no hair there. It’s literally anything a nerve can make you feel. And it can be of various degrees. It could be slight and minor, or it could be severe.” – Dr. Dana Cardinas
Acute Neuropathy
Most patients who receive oxaliplatin will experience some type of acute neuropathy. It may hit right away, but it typically does not last long, and symptoms subside within a few days after an infusion. It begins shortly after an infusion of oxaliplatin and gets better within a few days triggered by eating, drinking, or touching something cold or breathing cold air.
- Cold sensitivity to touch and/or drink
- Bite pain
- Finger cramping
- Finger locking
Chronic Neuropathy
Chronic neuropathy often begins around cycle six (on average). For some, it starts earlier, for some it starts later, and some patients never experience chronic neuropathy at all. Chronic neuropathy tends to impact the feet more than the hands. Some experience a slow onset of symptoms that build over time, and others may face extreme symptoms right away.
The risk of longer-lasting sensory neuropathy in your hands and feet increases as the amount of chemotherapy increases in your body. Symptoms may take 18 months to 2 years to go away completely. It is important to let your doctor know if symptoms last beyond a few days after treatment.
Neuropathy can get worse after you stop oxaliplatin because it continues to affect the nerves for anywhere between three to nine months after the last infusion.
How long does neuropathy last?
Like the onset of neuropathy, every patient is different. Some people do not have any problems with neuropathy after their last infusion. Some patients experience minimal issues, where neuropathy doesn’t bother them unless they do certain things. Others experience debilitating neuropathy, and it doesn’t go away. It’s important to both keep your health care team updated on your neuropathy symptoms, and to learn effective ways to manage them.
Managing neuropathy
At the very first sign of any nerve irritation while you are in active treatment, tell your oncologist. Early-stage neuropathy (between active treatment to a year after your last infusion) can be managed in the following ways:
Adjust Dosage and Rate
The dosage of oxaliplatin or the rate in which you receive chemotherapy may be adjusted to slow down or reduce nerve irritation. This will be dependent on your current state.
Lowering the dosage may help improve your neuropathy side effects, but ask your doctor about the pros and cons. You may also consider slowing down the rate of infusion, for example go from a two-hour infusion to a three, four or six-hour infusion.
Lifestyle Modifications
- Use gloves, warm socks, and scarves
- Eat room temperature food (not cold)
- Avoid excessive air-conditioning
- Use handrails and avoid clutter that may cause you to stumble or trip
- Protect your hands when getting items out of the refrigerator
- Wear special shoes to provide maximum comfort, like Hoka
As a stage III colorectal cancer survivor, Dr. Dana Cardinas is a strong proponent of icing. She discusses the truth behind it and how it could help CRC patients reduce cold sensitivity.
Combination Therapies
There is likely not one single strategy that will ease neuropathy symptoms or reduce the long-term symptoms. But several strategies working together can ease discomfort. Many patients suggest trying a couple of therapies for at least two weeks, and then see if the nerves respond. Nerves typically need time and patience. If you notice mild or moderate improvement, continue the strategy to see if it helps.
If any of these strategies make symptoms worse, discontinue right away. Always consult your doctor about the side effect management strategies you plan on attempting.
Many of these strategies will have maximum limits and can give you additional problems, like heart conditions and increased nerve pain, if taken without the guidance of a health care practitioner.
- Nerve glide exercises
- Vitamin Bs (B1, B6 and B12)
- Alpha lipoic acid
- Topicals (Biofreeze, SalonPas with lidocaine, capsaicin, frankincense oil mixed with almond oil)
- Hand putty or squeezy stress balls
- Feet rollers
- Foot elevation
- Sensory bins
- Acupuncture
- Reflexology
- CBD (tinctures, pills, vaping, or salves)
- Medical marijuana
- Oncology physical therapy
- Prescription meds (Gabapentin, Pregabalin, Cymbalta, Metanex)
Chemotherapy-Induced Peripheral Neuropathy Resources
These resources cover all things Neuropathy—why it happens, how to prepare for it, and methods to try and reduce its effects. Dana speaks from both the medical professional and patient angle, as she is a stage IIIC colon cancer survivor herself!
Common Questions
What does neuropathy feel like when it’s caused by chemotherapy?
Many describe it as tingling, “pins and needles,” burning or numbness in their hands or feet. Some say it feels like hair crawling on the skin where there’s no hair. Cold objects or drinks may trigger pain or spasms.
Can neuropathy from chemotherapy be prevented?
Prevention isn’t guaranteed, but risk can be reduced. Early symptom reporting, dose adjustment, slower infusion, and healthy lifestyle support your nerves. Some vitamin and exercise interventions show promise — always coordinate with your oncology team.
When should I speak up about neuropathy symptoms?
As soon as you notice tingling, numbness, increased sensitivity to cold, or difficulty with walking/balance. Early disclosure allows your care team to act. Waiting increases the chance of long-term nerve damage.
Does neuropathy always go away after treatment ends?
Not always. For some people symptoms diminish quickly; for others they persist for months or even years. The severity and duration vary widely. But even long‐term neuropathy can be managed more effectively when addressed early.
Should I consider physical therapy or other specialists?
Absolutely. If you’re experiencing neuropathy, ask your oncology team for a referral to oncology-trained physical/occupational therapy. Early rehabilitation can improve balance, strength, and nerve recovery.
Are there clinical trials aimed at neuropathy in colorectal cancer?
Yes. Research is active. Some trials focus on prevention (e.g., duloxetine in patients starting oxaliplatin) or interventions for existing neuropathy. If you’re eligible, ask about clinical-trial options. Learn more.