pain, post-amputation pain or pelvic floor myalgia. chemotherapy fig. 4: chemotherapy drugs chemotherapy may cause mucositis, muscle pain, joint pain, abdominal pain caused by diarrhea or constipation, and peripheral neuropathy chemotherapy-induced peripheral neuropathy between 30 and 40 percent of patients undergoing chemotherapy experience chemotherapy-induced peripheral neuropathy (cipn): tingling numbness, intense pain, and hypersensitivity to cold, beginning in the hands and feet and sometimes progressing to the arms and legs. chemotherapy drugs associated with cipn include thalidomide, the epothilones such as ixabepilone, the vinca alkaloids vincristine and vinblastine, the taxanes paclitaxel and docetaxel, the proteasome inhibitors such as bortezomib, and the platinum-based drugs cisplatin, oxaliplatin and carboplatin. whether cipn arises, and to what degree, is determined by the choice of drug, duration of use, the total amount consumed and whether the patient already has peripheral neuropathy. though the symptoms are mainly sensory – pain, tingling, numbness and temperature sensitivity – in some cases motor nerves are affected, and occasionally, also, the autonomic nervous system. cipn often follows the first chemotherapy dose and increases in severity as treatment continues, but this progression usually levels off at completion of treatment. the platinum-based drugs are the exception; with these drugs, sensation may continue to deteriorate for several months after the end of treatment. some cipn appears to be irreversible. pain can often be helped with drug or other treatment but the numbness is usually resistant to treatment. a 2007 american study found that most patients did not recall being told to expect cipn, and doctors monitoring the condition rarely asked how it affects daily living but focused on practical effects such as dexterity and gait. mucositis cancer drugs can cause changes in the biochemistry of mucous membranes resulting in intense pain in the mouth, throat, nasal passages, and gastrointestinal tract. this pain can make talking, drinking, or eating difficult or impossible. muscle and joint pain withdrawal of steroid medication can cause joint pain and diffuse muscle pain accompanied by fatigue; these symptoms resolve with recommencement of steroid therapy. chronic steroid therapy can result in aseptic necrosis of the humoral or femoral head, resulting in shoulder or knee pain described as dull and aching, and reduced movement in or inability to use arm or hip. aromatase inhibitors can cause diffuse muscle and joint pain and stiffness, and may increase the likelihood of osteoporosis and consequent fractures. radiotherapy radiotherapy may affect the connective tissue surrounding nerves, and may damage or kill white or gray matter in the brain or spinal cord. fibrosis around the brachial or lumbosacral plexus radiotherapy may produce excessive growth of the fibrous tissue (fibrosis) around the brachial or lumbosacral plexui (clusters of nerves), which can result in damage to the nerves over time (6 months to 20 years). this nerve damage may cause numbness, "pins and needles" (dysesthesia) and weakness in the affected limb. if pain develops, it is described as diffuse, severe, burning pain, increasing over time, in part or all of the affected limb. spinal cord damage if radiotherapy includes the spinal cord, changes may occur which do not become apparent until some time after treatment. "early delayed radiation-induced myelopathy" can manifest from six weeks to six months after treatment; the usual symptom is a lhermitte sign ("a brief, unpleasant sensation of numbness, tingling and often electric-like discharge going from the neck to the spine and extremities, triggered by neck flexion"), usually followed by improvement two to nine months after onset, though in some cases symptoms persist for a long time. "late delayed radiation-induced myelopathy" may occur six months to ten years after treatment. the typical presentation is brown-séquard syndrome (movement problems and numbness to touch and vibration on one side of the body and loss of pain and temperature sensation on the other). onset may be sudden but is usually progressive. some patients improve and others deteriorate. cited works fitzgibbon, dr; loeser, jd (2010). cancer pain: assessment, diagnosis and management. philadelphia. isbn 978-1-60831-089-0.