Peripheral Neuropathy and Lymphedema

Introduction

Peripheral neuropathy is damage to the nerves of the extremities (arms and hands or feet and legs) that can be caused by diseases such as diabetes, as a side-effect of chemotherapy, or nerve damage due to an injury such as a stroke. [1]

The symptoms of peripheral neuropathy are usually experienced first as tingling and numbness in the hands or feet. As the damage progresses the sensations are described as burning, throbbing, aching, and "feels like frostbite" or "walking on a bed of coals."[2]

Some lymphedema patients can also have peripheral neuropathy due to the effects of chemotherapy or other causes. Also when peripheral neuropathy blocks normal muscle movements lymphedema-like swelling may be present. When both conditions are present, it is necessary to modify the lymphedema treatment to accommodate the patient’s pain and the inability to feel abnormal pressure against the tissues.

Peripheral Neuropathy and Lymphedema Bandaging

Due to the loss of sensation in peripheral neuropathy the patient is unable to tell if bandages are too tight or are rubbing in places. This raises the question, “Can a person with peripheral neuropathy and who also has lymphedema use compression bandages?”

The answer to this question is, "Yes!" Your therapist will take special precautions and you need to learn to take similar precautions when self-bandaging. As Christine Thomas MSPT, CLT-LANA explained,

“Patients with peripheral neuropathy can (and should!) use compression bandages if this is required in treating their lymphedema. People in this category may have decreased sensation of the skin and muscle due to poor circulation, usually particularly at the feet area, so they should use a lot of cotton or foam padding under their bandages to protect the skin.

“Also the legs should be examined carefully after the bandages are removed to see if there are any reddened or sore looking areas. If there are, these areas should be given extra cushioning with the next bandage.”[3]

Additional Information

Most patients with these co-morbidities are unable to perform self-bandaging. In this case caregiver should be trained (by the patient's therapist) to perform the wrapping with the appropriate precautions including careful examination of the limb when the bandage is removed.

If the patient is wheelchair bound, they should be positioned with the affected leg so that the flow of lymph, an blood, are not blocked by the bend at the knee of the seated patient. 

References

[1] National Institutes of Health (NIH)

[2] Peripheral Neuropathy

[3] "The Answer is Yes!" e-mail correspondence with Christine Thomas MSPT, CLT-LANA.

[4] Living Well with Lymphedema by A. Ehrlich, A. Vinjé-Harrewijn PT CLT-LANA, and E. McMahon PhD. Lymph Notes. 2005 .

© LymphNotes 2009. This information does not replace the advice of a qualified health care professional.

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Category: Lymphedema and Other Conditions Updated: 2009-11-13