Why Does Cold Affect Patients Receiving Oxaliplatin?

Oxaliplatin is a platinum-based chemotherapy drug that kills cancer cells by binding to DNA. It also has toxic effects on the nervous system. Cold dysesthesia, one of its most characteristic side effects, results particularly from its effects on sensory nerve fibers.

What Is Oxaliplatin-Induced Cold Dysesthesia?

Cold dysesthesia is a side effect of the chemotherapy drug oxaliplatin that particularly affects the nervous system. It is one of the most common forms of acute peripheral neuropathy, usually described by patients as abnormal sensations when they come into contact with cold.

It may include:

• Tingling, burning or prickling when touching cold objects,
• Throat spasms or difficulty swallowing, particularly with cold drinks,
• Electric shock-like sensations in areas such as the hands, feet and around the face.

Biological Mechanisms

• Increased Excitability of Sensory Nerves (Hyperexcitability): Oxaliplatin increases electrical activity in Aδ and C sensory nerve fibers. This causes an exaggerated response to normally harmless cold stimuli. In particular, sensitivity increases in the cold-sensitive ion channels TRPM8 and TRPA1.
• Ion Channel Disruption in Nerve Membranes (Axons): Oxaliplatin affects voltage-dependent sodium (Na⁺) and potassium (K⁺) channels in nerve cell membranes. Imbalanced activity in these ion channels leads to spontaneous or exaggerated electrical signals in nerves. As a result, even a simple stimulus such as cold is felt as burning, prickling or electric shocks.
• Myelin Damage in Peripheral Nerves: With chronic use, oxaliplatin may damage the myelin sheath. Myelin loss disrupts nerve conduction, resulting in excessive sensitivity to cold.
• Nerve Conduction Disturbances Worsened by Cold: Low temperatures may block conduction in nerves damaged by oxaliplatin. Already sensitized nerve endings therefore send more irregular signals in response to cold, producing unpleasant sensations.

How Long Does It Last? Is It Permanent?

It usually begins in the first hours or within the first 2 days after drug administration. It is temporary and generally resolves on its own within a few days. Very rarely, it may be permanent in some patients. 

Are There Devices or Equipment for Protection?

Yes, certain equipment and supportive methods may help:

• Thermal Gloves / Heated Glove Pads: Gloves containing electrical or chemical warmers may reduce sensitivity in the fingertips. They are particularly recommended when going outdoors in winter.
• Heated Socks or Foot Pads: Heated or thermal socks may be used to reduce the effects of cold floors.
• Cryoprotection Devices (The Reverse of Cryotherapy): Some clinics are trying anti-cold approaches instead of cryotherapy, using devices that keep the extremities warm. For patients receiving oxaliplatin, heat-retaining gloves or socks rather than conventional cooling may reduce cold dysesthesia.
• Devices That Prevent Contact With Cold: Coated or insulated handles can help prevent contact with metal surfaces, for example special covers for shopping cart handles. Insulated drink bottles also prevent direct contact with cold beverages.

These devices may help prevent symptoms, but no device guarantees complete protection. Protective devices should be combined with behavioral precautions, such as consuming warm foods and avoiding cold environments.

Suggestions for Managing Cold Dysesthesia

Protect Yourself From Cold: Avoid cold air, drinks and objects. Wear protective clothing such as gloves, socks and scarves, especially when going outdoors in winter. Do not take items directly from the refrigerator or freezer.

Choose Warm Foods and Fluids: Avoid cold water, ice cream and iced drinks for several days after treatment. They may cause prickling in the mouth or a feeling of throat spasm, so choose lukewarm drinks.

Be Careful With Electrical Appliances: Avoid touching cold metal surfaces or electrical appliances, such as refrigerator doors and shopping carts, with bare hands.

Protect Your Hands and Feet: Wash your hands with lukewarm water and avoid cold water. If needed, you can use heated hand and foot pads at home.

Talk to Your Doctor: If cold dysesthesia affects your quality of life, your doctor may adjust the dose or plan supportive treatment to relieve symptoms. Vitamin B supplements or medicines aimed at reducing neuropathy may be appropriate for some patients.