A glass of chilled water, a cold breeze, or a quick touch of a refrigerator door may seem harmless. But for some people undergoing chemotherapy, these everyday moments can trigger a sudden wave of pain, tingling, or burning. This unusual reaction, known as cold allodynia, happens when chemotherapy affects the nerves and makes them respond abnormally to cold.
The sensation can be especially noticeable with certain chemotherapy medicines. Explaining why this happens, Dr Ranjith G, consultant neurologist at Apollo Hospitals, Financial District, says, “Chemotherapy drugs can irritate and damage peripheral sensory nerves. Cold temperatures can activate abnormal ion channels in these nerves, making them excessively excitable. As a result, a normally harmless cold stimulus sends unusually strong pain signals to the brain. This is known as cold allodynia.”
Talking about the symptoms of cold allodynia, Dr Rajesh Bollam, senior consultant medical oncologist and hemato-oncologist at Renova Soumya Cancer Centre, Karkhana, shares, “Patients describe it in different ways. Some experience sharp, electric, burning, tingling or pins-and-needles sensations when exposed to something cold. For example, a patient may experience pain or intense tingling while drinking refrigerated water or other cold beverages, taking food directly from a refrigerator, touching a cold bottle, metal surface or refrigerator shelf, washing their hands in cold water, going outdoors in cold weather and sitting directly under strong air-conditioning. While, some patients receiving oxaliplatin also experience an unusual sensation of tightness or difficulty swallowing when drinking something cold. Occasionally there can be a frightening sensation of throat tightness or difficulty breathing — known as laryngopharyngeal dysesthesia. Patients should report this promptly so that the treating team can distinguish it from other causes, including an infusion-related allergic reaction.”
For patients, this can become noticeable during their treatment journey, with symptoms varying over the course of chemotherapy. Speaking about the different patterns patients may experience, Dr Rajesh narrates, “Acute oxaliplatin neurotoxicity is extremely common. The second is cumulative peripheral neuropathy. After repeated cycles, patients may develop persistent numbness, tingling, altered sensation, or pain in their hands and feet. This can take months to improve after chemotherapy and, in some patients, may remain long-term. Importantly, patients should not assume that increasing numbness is simply something they have to tolerate. Early reporting allows the oncologist to consider treatment modification before neuropathy becomes functionally significant.”
As these symptoms can interfere with everyday activities, taking simple precautions can help patients manage the discomfort, particularly around treatment. Suggesting ways to reduce symptoms, Dr Ranjith expresses, “Persistent numbness, weakness, difficulty walking, dropping objects, problems with fine movements, or symptoms continuing between chemotherapy cycles may indicate more significant neuropathy. Patients should promptly inform their oncology team if these occur. Avoiding very cold drinks, foods, air-conditioning exposure, and direct contact with refrigerated or frozen items can reduce symptoms. Wearing gloves and keeping the body warm may help. Doctors can assess severity, adjust chemotherapy when appropriate, and recommend suitable treatments for troublesome neuropathic symptoms.”
For patients, understanding that these reactions can occur during chemotherapy can make an otherwise ordinary sensation easier to recognise and respond to. Staying warm, limiting cold exposure, and reporting persistent or worsening symptoms can help doctors address nerve problems before they interfere more seriously with everyday life.