Can Radiation Therapy Cause Neuropathy and How to Cope

Yes radiation therapy can, in certain situations, contribute to nerve injury and neuropathy, though it is relatively uncommon compared with neuropathy caused by chemotherapy. [PM19] Radiation near the spinal cord can lead to neurological toxicity (radiation myelopathy), and high doses near nerve bundles (like the brachial plexus in head-and-neck or breast areas) can cause plexus-related neuropathy. ^[1] Brachial plexus–associated neuropathy has been reported after high‑dose radiation for head and neck cancers, with risk linked to dose and field proximity to the plexus. [PM16] In nasopharyngeal cancer, radiation‑induced brachial plexopathy typically appears years after treatment and can cause tingling, pain, and weakness. [PM17]

At the same time, neuropathy is more commonly a side effect of specific chemotherapy drugs (for example, taxanes, platinums, vinca alkaloids, bortezomib), which many people receive before or after radiation. ^[2] Oxaliplatin is a well‑known example that can cause acute cold‑triggered tingling and delayed sensory changes. ^[3] Carboplatin has a lower incidence of neuropathy than cisplatin but can still cause mild paresthesias, especially in older adults or those previously exposed to cisplatin. ^[4] Many cancer centers provide rehabilitation and symptom control programs because neuropathy can affect balance, walking, and daily function. ^[5]

What Neuropathy Feels Like

• Neuropathy can present as numbness, tingling, burning pain, weakness, reduced coordination, or balance problems, most often in hands and feet. ^[5]
• Radiation plexopathies may start with paresthesia and progress to pain or weakness months to years after treatment depending on dose and location. [PM17]
• When the spinal cord is within or near the radiation field, transient electric‑shock sensations (Lhermitte’s sign) or more serious myelopathy can occur, depending on dose and timing. ^[1]

How Often Does It Happen?

• Radiation‑induced peripheral neuropathies are considered rare and have become less frequent with modern planning and dose limits, but they remain clinically important in long‑term survivors. [PM19]
• Brachial plexus neuropathy risk rises with higher doses to the plexus and larger fields in head‑and‑neck or breast/axillary treatments. [PM16]
• In nasopharyngeal cancer cohorts, onset averaged around 4 years after therapy in reported cases, highlighting a late complication pattern. [PM17]

Who Is at Higher Risk?

• Higher radiation dose to nerve structures (e.g., brachial plexus or spinal cord) and field overlap increase risk. [PM16] ^[1]
• Combined‑modality therapy with neurotoxic chemotherapy agents (like oxaliplatin, taxanes, vinca alkaloids) raises the chance of neuropathy overall. ^{[2] [3]}
• Prior cisplatin exposure and older age can increase neuropathy risk with carboplatin as well. ^[4]

Coping and Management Strategies

• Many centers provide structured guidance to manage peripheral neuropathy, focusing on safety, symptom relief, and maintaining independence. ^[5]
• Rehabilitation (physical and occupational therapy) can help improve strength, balance, gait, and daily function. ^[5]
• Medications for neuropathic pain are commonly used when needed, tailored to your symptoms and tolerability. ^[5]

Practical Safety Tips at Home

• Wear supportive, low‑heeled shoes or sneakers to protect feet and improve stability. ^[6]
• Use gloves and warm socks in cold weather to reduce cold‑triggered tingling and protect sensation. ^[6]
• Choose easy‑to‑handle clothing and jewelry to accommodate dexterity changes. ^[6]
• Keep floors clear, use night lights, and consider assistive devices if balance is affected to reduce fall risk. ^[5]
• Inspect hands and feet regularly to catch minor injuries early since reduced sensation can hide damage. ^[5]

Rehabilitation and Activity

• Physical therapy can build strength and improve balance, and occupational therapy can adapt daily tasks to your abilities. ^[5]
• Targeted exercises and gait training help prevent neuropathy from limiting walking or daily activities. ^[5]

Medication Considerations

• Your care team may suggest medicines commonly used for neuropathic pain to ease discomfort while monitoring side effects and interactions. ^[5]
• If chemotherapy is ongoing, clinicians may adjust dosing for agents known to cause neuropathy (for example, oxaliplatin dose modifications for persistent symptoms). ^[3]

When to Seek Medical Help

• New or worsening numbness, tingling, burning pain, weakness, or balance problems should be reported promptly, especially if symptoms appear months to years after radiation in areas near major nerve structures. [PM17]
• Sudden electric‑shock sensations down the spine or significant changes in coordination warrant evaluation to differentiate transient radiation effects from other causes. ^[1]

Key Takeaways

• Radiation can cause neuropathy when nerve structures receive higher doses, but this is relatively rare with modern techniques. [PM19] ^[1]
• Chemotherapy causes neuropathy more often; knowing your drug exposure helps predict risk and guide prevention. ^{[2] [3] [4]}
• Early rehabilitation, safety measures, and symptom‑focused medications can meaningfully improve quality of life. ^{[5] [6]}

If you’d like help tailoring these tips to your treatment history and current symptoms, I can walk you through a personalized plan.