StageIV with Peripheral Neuropathy

Posted by lgk2948 @lgk2948, Jan 15 5:47pm

My spouse was diagnosed with stageVI Pancreatic cancer on July 3, 2023, the tumor is located on an artery which means no whipple. Her C19 have dropped from 8500 to 300 as of 1/3/2024. According to the last PET scan and CT scan her tumor has shrunk to barely noticeable, additional the lesions on her liver are gone. The treatment consisted of 9 sessions of Folfirinox prior to the scans and Gemicitiban+Abraxane for the last two sessions. At this point the neuropathy in her hands and feet have increased. She can no longer knit and has difficult holding a cup to drink with, she can feed herself but it is a major task for her. She can walk, but has pain, tingling and pins feeling in both hands and feet. The oncologist is changing her regime to exclude Abraxane in the hopes of lessing the neuropathy. We currently are using icy/hot on both her hands and feet and I have purchase wool socks which should arrive today. We were doing acupuncture but discontinued prior to Christmas. I massage her feet and legs with the icy hot. Any suggestions to help dela with this situation.

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mayoconnectuser1 | @mayoconnectuser1 | Jan 16 9:23am

lgk,

Where is she being treated? Although difficult, I always recommend relocation to a pancreatic center of excellence - as quickly as possible, and for the entire time of treatment, including surgery.

Quick note - unless the decision to not attempt a Whipple was made at one of these centers, it may not represent reality as much as the current facility's inability to do them under tough circumstances as you noted.

katiegrace | @katiegrace | Jan 16 4:25pm

If you search neuropathy on mayo connect, you should find some more helpful advice for neuropathy.
Some things to help neuropathy, that I have found on this site are:
ZopecDT-1200 tens unit - others in the MN Neuropathy Assoc have had success using it.
Nerve related supplements - CoQ10, Acetyl-Carnitine HCL, Alph-Lipoic Acid - one capsule
Scrambler therapy
I have not tried any of these things. I've heard what helps one person may not help another person.
Best wishes.

stageivsurvivor | @stageivsurvivor | Jan 17 5:11pm

Once chemo induced peripheral neuropathy (CIPN) has manifested, treatments are for alleviating discomfort. If the peripheral nerves are not damaged beyond repair, they have the capacity to regenerate. I had 24 cycles of the original dose of Folfirthatnis 20% higher than (m)Folfirinox. My oncologist alternating the dosing every six with six resting cycles of 5-FU/Leucovorin. This is likely the reason my neuropathy was not permanent. I had no improvement for 2.5 years after finishing Folfirinox.From that point, improvement was slow and steady and took over five years to fully resolve.

During this time I did things to promote blood circulation in hopes of nerve regeneration/growth. I frequently soaked my feet in warm water and massaged them a couple of times a day. In warm weather I found walking on warm beach sand therapeutic. During the time I experienced the most discomfort, I found gabapentin provided relief. Wearing socks to bed helped. Some people report they get temporary relief from acupuncturist but requires repeating. I didn’t use it because I found taking gabapentin wherever I was to be more convenient and less cost in making and traveling to acupuncture appointments.

Here are some links on CIPN
PHYSIOTHERAPY FOR PERIPHERAL NEUROPATHY
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808681/
MASSAGE THERAPY FOR NEUROPATHY
https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-023-03485-z
STUDY ON TECHNIQUES TO ALLEVIATE CIPN
https://pubmed.ncbi.nlm.nih.gov/36810482/
ACUPUNCTURE FOR PERIPHERAL NEUROPATHY
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476456/
Duloxetine (Brand name Cymbalta)
“Evidence from preclinical [58, 59] and clinical studies [4] suggests that duloxetine, an antidepressant drug acting as a serotonin-noradrenaline reuptake inhibitor (SNRI), may be effective in the prevention of CIPN without reducing the antitumor activity of oxaliplatin [49]”.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329798/
https://assets.researchsquare.com/files/rs-353734/v1/a52ab5a9-a8da-4552-b619-a94a48249d6b.pdf?c=1649972592