CIPN Rehabilitation in Adults: Therapist Insights on Managing Chemotherapy-Induced Peripheral Neuropathy
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and often debilitating side effect of chemotherapy, impacting over 60 percent of adult patients.1 As advancements in cancer treatment improve survival rates, the demand for specialized CIPN rehabilitation is growing. For rehabilitation professionals, this presents an opportunity to deliver impactful care that improves patients’ quality of life.
As a retired occupational therapist and certified hand therapist (CHT), I’ve gained extensive experience working with patients affected by CIPN. In this article, I provide insights from my clinical practice, offering strategies to generate referrals, provide symptom management, and emphasize the importance of multidisciplinary care in CIPN treatment and rehabilitation.
My journey to CIPN rehabilitation
Fourteen years ago, I was working full-time in orthopedic hand therapy when I first encountered patients struggling with chemotherapy-induced peripheral neuropathy. At that time, referrals for CIPN were rare, and the condition was not widely recognized as treatable through rehabilitation.
It wasn’t easy to get my first referrals, but a breakthrough came when I built a relationship with an oncology clinical research group. Their patients were participating in clinical trials that included chemotherapy drugs known to cause CIPN. The primary reason patients had to withdraw from these potentially life-saving trials was the severity of their neuropathy symptoms. However, the research team began to notice that the patients I treated for CIPN rehabilitation were able to tolerate their chemotherapy regimens with fewer and less severe symptoms.
As word of these positive outcomes spread, patients began sharing their rehabilitation experiences with their “infusion buddies”—fellow patients receiving treatment alongside them. These infusion buddies, inspired by what they heard, started asking their oncology teams for referrals to CIPN rehabilitation. Over time, the oncology team’s trust in my approach grew, and referrals increased significantly. Eventually, patients with CIPN made up half of my caseload.
The emotional impact of this work has stayed with me. Some patients cried during their first session, overwhelmed with relief that someone was finally listening to their symptoms instead of dismissing them as untreatable. I often encouraged patients to bring a friend, significant other, or family member to their therapy sessions. In many cases, it was these loved ones who expressed the most gratitude—not only for being heard but also for learning practical symptom management techniques they could support at home.
The strategies and techniques I developed throughout my years of working with CIPN patients are now shared in three specialized Medbridge courses:
- Introduction to Chemotherapy-Induced Peripheral Neuropathy in Adults
- Evaluation of Chemotherapy-Induced Peripheral Neuropathy in Adults
- Treatment of Chemotherapy-Induced Peripheral Neuropathy in Adults
These courses provide you with the knowledge and tools needed to evaluate, manage, and treat CIPN effectively, helping improve patient outcomes and quality of life.
How to generate referrals for CIPN rehabilitation
Building a steady flow of referrals is key to growing a successful CIPN rehabilitation program. While oncology teams are often aware that CIPN is a common side effect of chemotherapy, they may not realize that rehabilitation can play a significant role in managing its symptoms.
Establishing strong relationships with oncology providers and encouraging patients to share their rehabilitation successes can go a long way toward improving referral rates for CIPN treatment. Here are a few strategies that worked well for me in the early stages of building my CIPN program:
- Empower patients as advocates: Encourage your patients to share their positive rehabilitation experiences with their medical team. If your work has improved their symptoms or quality of life, their firsthand feedback is incredibly powerful. My patients were my best champions of my CIPN rehabilitation program. I’ve learned that favorable feedback from patients gets the medical team’s attention far more effectively than a marketing visit or brochure that might be passed on or tossed.
- Offer screening tools: Provide oncology teams with simple screening tools to identify CIPN symptoms. Ask patients about experiencing any pain, numbness, tingling, or burning sensations in their hands or feet to initiate discussions about rehabilitation and increase referrals.
- Build collaborative relationships: Take time to connect directly with oncologists, nurses, and clinical researchers. Offering to collaborate on patient care plans or providing updates on mutual patients’ progress helps build trust and highlights the role of rehabilitation in improving outcomes.
Strategies to improve well-being in CIPN care
A cancer diagnosis brings significant physical, emotional, and psychological stress. For patients experiencing CIPN, rehabilitation should focus on calming the nervous system and restoring function. Breaking this process into targeted approaches makes the care more effective and digestible.
The following five strategies provide a practical and structured framework to address the unique challenges of CIPN:
1. Address anxiety and stress
A diagnosis of cancer is scary. It is normal for patients to experience anxiety, stress, or even an existential crisis in response to such a significant life event. Life is complicated, and many patients may already be dealing with challenges in their ‘normal’ lives even before their cancer diagnosis. For those experiencing CIPN, this emotional distress can further heighten their symptoms and amplify the nervous system’s reactivity.
Rehabilitation for CIPN should include techniques designed to calm the patient and quiet their nervous system, which is likely to be amped up. We calm people by promoting relaxation, listening to their needs, and exploring pain-relieving and sensory-normalizing interventions. Teaching deep breathing exercises, progressive relaxation techniques, or mindfulness-based practices can help reduce anxiety and stress.
2. Managing fatigue and inactivity
Patients on chemotherapy often experience fatigue, which can exacerbate CIPN symptoms by limiting circulation and increasing nerve sensitivity. Their daily routines are disrupted, and they may be far less physically active than they had been before starting cancer treatment. All these details can contribute to inactivity, poor posture, and disuse, which in turn promote stasis and a sluggish lymphatic system, further compromising sensation.
Pleasant pain-free scapular stabilization can be very effective in symptom management for CIPN, as it helps improve posture and relieve areas of nerve compression that contribute to discomfort. Other suggestions include pain-free AROM of upper and lower extremities, changing positions more often to promote circulation, and sensory stimulation techniques. Below, you can watch an upper extremity active range of motion demonstration from my Medbridge course, Treatment of Chemotherapy-Induced Peripheral Neuropathy in Adults.
Additionally, coordination exercises, careful and safe balance exercises, and a home exercise program that is pleasant and brief—such as simple stretches or gentle range of motion exercises—can be very effective.
3. Restoring sensation and reducing pain
Some chemotherapy drugs are more associated with symptoms of numbness and tingling due to their effects on sensory nerves, particularly those responsible for detecting vibration and light touch. Other drugs are more likely to cause symptoms of burning pain or cold intolerance, as they may irritate or damage small nerve fibers that regulate temperature and pain perception.
CIPN symptoms require interventions that are appropriate to the clinical presentation. For example, patients experiencing numbness and tingling may benefit from sensory stimulation and gentle nerve mobilization, while those with burning pain or cold intolerance may respond better to gentle strengthening exercises and targeted AROM interventions tailored to their comfort levels. I have found that symptoms of numbness and tingling respond well to a combination of AROM, gentle and pain-free nerve mobilization, appropriate manual therapy, and sensory stimulation. I have found that symptoms of burning pain or cold intolerance respond more effectively to gentle AROM and gentle strengthening exercises.
4. Enhancing coordination and balance
Coordination and safe balance exercises can be highly effective for patients whose proprioception (position sense) or balance has been compromised by CIPN. I have found that simple interventions, such as tandem walking along a straight line or performing gentle weight shifts while standing, can help improve stability. These exercises may seem basic, but they address the core challenges that patients face with balance and coordination.
Restoring stability not only improves functional mobility but also builds the patient’s confidence in performing daily activities safely. For patients with CIPN, regaining a sense of control over their movements can significantly enhance their overall quality of life.
5. Designing a home program
Designing a home exercise program that is brief, effective, and easy to integrate into daily life ensures better adherence. Low-impact exercises that are quick to perform and adaptable to the patient’s environment are often the most successful. Examples include seated stretches, gentle walking routines, or light resistance exercises that promote circulation and function without causing discomfort or fatigue.
A home exercise program should be tailored to the patient’s symptoms and functional goals, encouraging gentle activity while minimizing discomfort. For example, a simple program might include gentle upper and lower extremity stretches to improve range of motion, seated posture corrections to relieve nerve compression, and short walks to promote circulation without causing fatigue. Keeping the exercises brief and manageable increases the likelihood of adherence and ensures the patient feels empowered rather than overwhelmed.
The value of multidisciplinary care in CIPN rehabilitation
The ideal treatment team for CIPN rehabilitation is a multidisciplinary team. Each team member plays a critical role in improving outcomes, ensuring that patients receive comprehensive care tailored to their symptoms and functional goals. There are roles for occupational therapists, hand therapists, physical therapists, and lymphedema therapists.
Balance problems can occur with CIPN of the lower extremity, partly because proprioception is often affected due to sensory nerve damage. Therapists with training in vestibular rehabilitation are well-equipped to address these deficits with targeted interventions to improve stability and mobility. Lymphedema therapists can be instrumental in safely reducing swelling, which relieves physical pressure on nerves and reduces symptoms like numbness, tingling, and pain. Improved circulation resulting from swelling reduction further supports nerve healing and sensory recovery. When these disciplines work together in a collaborative, multidisciplinary approach, the result is comprehensive care that addresses both the physical and functional challenges of CIPN, ultimately enhancing the patient’s quality of life.
Expanding opportunities for CIPN care
As cancer treatments evolve, the role of rehabilitation professionals in managing chemotherapy-induced peripheral neuropathy continues to grow in importance. By implementing tailored interventions, building strong relationships with oncology teams, and addressing both the physical and emotional challenges of CIPN, therapists can empower patients to reclaim their function and quality of life. This collaborative, patient-centered approach enhances outcomes and raises awareness of rehabilitation as a vital component of cancer care.
My work with CIPN patients has been the most moving and rewarding experience of my long professional career. Although I am now retired from clinical practice, I remain deeply passionate about promoting greater understanding and interest in CIPN rehabilitation among my peers. By building expertise and embracing the unique challenges of this population, rehabilitation professionals can deliver life-changing care to those who need it most.
I hope this article inspires more therapists to step into this growing field and create valuable opportunities for patients to receive the quality care they deserve.
References
- Kim, J. H., Dougherty, P. M., & Abdi, S. (2015). Basic science and clinical management of painful and non-painful chemotherapy-related neuropathy. Gynecologic oncology, 136(3), 453–459. https://doi.org/10.1016/j.ygyno.2015.01.524
