Peripheral neuropathy from myeloma treatment: Managing nerve damage
Fact-checked by Peripheral neuropathy, a type of nerve damage, is a common side effect of certain myeloma treatments.
While this side effect can often be reversed with adjustments to the treatment regimen and supportive care, the damage may be permanent for some people. Individuals should alert their care team as soon as they experience potential symptoms of nerve damage, because early intervention leads to the best outcomes.
What is peripheral neuropathy?
The peripheral nerves are the network of nerves found outside the brain and spinal cord. They connect the central nervous system to the rest of the body, enabling movement, providing sensation, and controlling automatic bodily functions.
Peripheral neuropathy occurs when these nerves become damaged. A variety of factors can cause this nerve damage, including physical injuries, infections, diabetes, toxin exposure, and specific medications.
Why some myeloma treatments damage nerves
Some cancer drugs, including options used to treat myeloma, can cause peripheral neuropathy. Broadly, this happens because the toxic effects of these medications are not entirely specific to cancer cells; they can also damage healthy cells, including peripheral nerve cells.
The myeloma treatments most commonly associated with peripheral neuropathy include:
Velcade is a proteasome inhibitor. While other medications in this class can also cause nerve problems, they do so less frequently. Thalomid is an immunomodulatory agent that is more likely than others in its class to cause nerve damage. Traditional myeloma chemotherapy agents could also cause neuropathy.
The risk of peripheral neuropathy with these medications typically increases at higher doses. With bortezomib, neuropathy is also more likely to occur when the medication is given via infusions into the bloodstream rather than through under-the-skin injections.
Notably, myeloma itself can cause peripheral neuropathy, meaning these symptoms could reflect a combination of disease and treatment effects for some people.
Common signs of treatment-related neuropathy
The symptoms of peripheral neuropathy depend on which nerves are mainly affected. Damage to sensory nerves may cause:
- numbness, tingling, burning, or other abnormal sensations, especially in the hands and feet
- sensitivity to touch
- lack of temperature sensation
- loss of proprioception, which is the ability to feel and know where the feet are on the ground
- loss of balance when the eyes are closed
- loss of reflexes
- ringing in the ears or hearing trouble
Motor nerve damage may cause:
- weakness or cramps
- muscle loss
- decreased reflexes
- difficulty using the hands for fine motor tasks like writing or grabbing objects
- loss of coordination or frequent falling
Damage to the autonomic nerves that control involuntary body functions may cause:
- heat intolerance and decreased sweating
- difficulty adjusting the eyes in the dark
- dizziness or lightheadedness when sitting up or standing up
- digestive problems
- urinary or bladder issues
- erectile dysfunction
Individuals should alert their care team as soon as they experience any possible signs of nerve damage, even if the symptoms are mild. Managing mild symptoms is significantly easier, and delaying care increases the risk of permanent nerve damage.
Managing neuropathy
The exact treatment for peripheral neuropathy in myeloma depends on several factors, including the severity of nerve-related symptoms.
Often, managing the issue involves making adjustments to the myeloma treatment regimen, such as lowering the dose or frequency of the offending medication, pausing treatment, or switching medications.
A comprehensive treatment plan may also involve:
- over-the-counter or prescription medications to manage nerve pain
- neuroprotective vitamins or supplements, such as vitamins B6 and B12
- supportive care measures, including acupuncture
- lifestyle adjustments, such as regular exercise, dietary changes, and staying hydrated
The specific approach will depend on the exact symptoms, their severity, and other health-related factors. Individuals should talk with their care team before making any changes.
Some evidence suggests that cooling methods may help prevent nerve damage. When a person is cold, blood vessels constrict, and blood flow slows, preventing more of the offending medication from reaching the hands and feet. A doctor may recommend using ice packs, cooling gloves, or cooling socks while receiving treatment.
Nerve damage from myeloma treatment may be reversible with appropriate care, but in some cases, the damage may be permanent.
Questions to ask your care team
When dealing with neuropathy, individuals should consider asking their care team the following questions:
- Are these symptoms likely from the myeloma itself or from my treatment?
- How should I be tracking my neuropathy symptoms at home?
- Would adjustments to my myeloma treatments help? If so, will this have a negative effect on my myeloma control and long-term outlook?
- What medications or lifestyle changes might help manage these side effects?
- What nerve-related symptoms require urgent medical care?
- Are my neuropathy symptoms likely reversible?
Rare Cancer News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
