# Chemotherapy nerve damage (peripheral neuropathy): assessment, dose changes and prevention

Source: https://onco.cc/protocols/chemotherapy-induced-peripheral-neuropathy-assessment-and-prevention/  
OnCo record `chemotherapy-induced-peripheral-neuropathy-assessment-and-prevention` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Some chemotherapy drugs, such as paclitaxel, docetaxel, oxaliplatin, vincristine and bortezomib, can damage the nerves in the hands and feet, causing tingling, numbness or pain. Tell your team at every visit: the dose can be lowered or delayed before the damage lasts. No medicine is proven to prevent it; cooling or compressing the hands is being tested. Duloxetine can help painful nerve damage.

## Summary

ASCO (2020) found that no agent is recommended to prevent CIPN and discourages acetyl-L-carnitine. Clinicians should consider dose delay, dose reduction, substitution or stopping the drug in people who develop intolerable neuropathy or loss of function; duloxetine is the only drug with appropriate evidence for established painful CIPN, and its benefit is limited. Assessment rests on asking at every cycle: an Australian Delphi consensus (2022) agreed on education before treatment, a history to find risk factors, closer monitoring or a baseline neurological assessment for people with existing neuropathy, screening with a short patient-reported questionnaire at every treatment cycle and at follow-up, and encouraging physical activity.

On prevention by cooling or compression, randomised evidence has grown since ASCO 2020. In POLAR (2025, 122 women on weekly paclitaxel or nab-paclitaxel, one hand treated and the other as control), a frozen glove or two surgical gloves one size too small, worn from 30 minutes before to 30 minutes after the infusion, each reduced grade 2 or higher sensory CIPN (cooling 29 against 50 per cent; compression 24 against 38 per cent). In CryoPac (2026, 268 randomised, frozen gloves and socks), cryotherapy did not significantly reduce CIPN at the end of treatment (74 against 84 per cent) but reduced patient-reported tingling and numbness, with 67 per cent compliance. No guideline read has yet graded these trials.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: CIPN assessment; chemotherapy-induced peripheral neuropathy; frozen gloves during paclitaxel; surgical glove compression during taxanes; cryotherapy for neuropathy; duloxetine for chemotherapy neuropathy
- Tags: protocol; neuropathy; supportive-care

## Connected records

- ideas: [A prevention programme for chemotherapy nerve damage: SARM1 inhibitors, cooling and compression](https://onco.cc/ideas/idea-moon-neuropathy-prevention-programme/), [Choose cold or compression for neuropathy by what patients can keep on](https://onco.cc/ideas/idea-mach-cold-or-compression-by-adherence/), [Frozen gloves or tight surgical gloves offered during every weekly taxane infusion](https://onco.cc/ideas/idea-upgrade-hand-foot-cooling-compression-during-taxanes/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Frozen gloves, socks and compression for taxane nail and nerve damage](https://onco.cc/technologies/frozen-gloves-compression-taxane/), [Limb cryocompression devices for chemotherapy nerve damage (Paxman Neuropathy System, Hilotherm ChemoCare)](https://onco.cc/technologies/limb-cryocompression-devices/)
- drugs: [Bortezomib](https://onco.cc/drugs/bortezomib/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Nab-paclitaxel](https://onco.cc/drugs/nab-paclitaxel/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Vincristine](https://onco.cc/drugs/vincristine/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)
- terms: [Peripheral neuropathy (chemotherapy-induced)](https://onco.cc/terms/peripheral-neuropathy/)
- protocols: [Chronic pain in cancer survivors: assessment, non-opioid treatment first and careful opioid use](https://onco.cc/protocols/chronic-pain-in-cancer-survivors/)

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