7 Ways to Manage Peripheral Neuropathy Linked to Multiple Myeloma

If you have multiple myeloma, symptoms such as fatigue and bone pain are a given. But numbness, pain, or tingling in your arms and legs may surprise you.

These sensations have a name: peripheral neuropathy (PN). PN affects the peripheral nervous system, aka the nerves that send and receive signals between your brain, spinal cord, and the rest of your body. When these nerves become damaged or inflamed, from the cancer itself or medications used to treat myeloma, it changes the way those nerves work.

These changes cause a variety of symptoms, depending on the damage and which of the three pathways in the peripheral nervous system is being affected. And they can have an impact on your daily life in ways big and small. But there are doctor-recommended tips that can ease the worst of these sensations.

What Causes Peripheral Neuropathy in Multiple Myeloma

About 1 in 5 people living with multiple myeloma develop peripheral neuropathy, according to the International Myeloma Foundation. If you’re among them, there may be several reasons:

• Your treatment is causing damage. This is the most common reason people with multiple myeloma develop peripheral neuropathy, says Syed Abbas Ali, MBBS, an assistant professor of oncology at Johns Hopkins Medicine in Baltimore. Several medications commonly used to treat myeloma, including bortezomib (Velcade), pomalidomide (Pomalyst), and thalidomide (Thalomid), are known to affect nerves, according to the International Myeloma Foundation.
• The disease is triggering the damage. There are several theories to support this connection. One is that proteins being secreted by cancer cells may harm nerve cells and impair their ability to send signals. Another is that multiple myeloma has weakened or fractured the bones in the spinal cord, causing them to press down on the nerve roots.
• You have another health issue that causes PN. Diabetes and other autoimmune conditions can cause PN, says Dr. Ali.
• Your vitamin D levels are low.  Research shows peripheral neuropathy and low vitamin D levels are common in people with myeloma. Getting more vitamin D from food or supplements could reduce that risk.

What Peripheral Neuropathy Feels Like

The way PN impacts you depends on whether it’s affecting your sensory, motor, or autonomic nerves.

“People with peripheral neuropathy can feel as if their fingers or toes have fallen asleep or they have a pins and needles sensation,” says Ali. “They can have trouble with buttons or zippers. It can be hard to open jars, and it’s not uncommon to drop objects.”

Other symptoms of sensory PN include feeling as though your hands, feet, arms, or legs are burning, freezing, or throbbing or you experience jabbing pain. Or you may feel like you’re wearing gloves or socks, or your have sand or gravel in your shoes. You may feel off-balance, too, or have ringing in your ears (tinnitus).

People with motor peripheral neuropahty may have weakness or cramping in muscles or trouble writing. Other symptoms include digestive issues, lightheadedness (from changes in blood pressure), erectile dysfunction, and a frequent urge to go to the bathroom.

How to Ease Symptoms of Peripheral Neuropathy

Treating peripheral neuropathy can be challenging for both the person living with it and their health care provider, says Edward A. Faber, Jr., DO, an associate professor of clinical medicine and hematologist/oncologist at University of Cincinnati Health. “The precise mechanisms of how the nerves are damaged is not well understood,” he says. “So it’s difficult to create a well-proven treatment strategy that works for [everyone].”

Your doctor may try a variety of tactics, such as switching medications or adding integrative or complementary medicine. Some approaches include:

1. Changing Existing Treatments

Your doctor may lower the dose, change the timing of, or altogether stop a medication to see whether your peripheral neuropathy symptoms improve. If they do not, there are good alternative medications to try, Dr. Faber says.

“When we didn’t have as many therapy choices for myeloma, we were forced to tolerate side effects like neuropathy,” he says. “We are now in the ‘age of choices’ for multiple myeloma patients. There are many more medications and combinations of medications today.”

2. Adding Prescription Drugs to Relieve Symptoms

“Bringing anxiety and depression under control can really make a difference with peripheral neuropathy,” Ali says. Doctors can prescribe antidepressants such as duloxetine (Cymbalta), he adds. Anti-seizure drugs such as pregabalin (Lyrica) and gabapentin (Neurontin) can also help reduce nerve pain. So can ordinary pain relievers. But physicians try to limit myeloma patients’ use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and naproxen (Aleve), because they can damage the kidneys.

3. Taking Supplements

These can include vitamin D, if your levels are low, or antioxidants, such as vitamins C and E, Faber says. B vitamins, with or without folic acid, can also be helpful. The usual daily dose of B6 is 50–100 milligrams a day, so read the supplement label, because higher doses could be toxic to nerves, Faber says. Don’t forget to include the amount of B6 in your daily multivitamin when choosing a supplement, he adds.

4. Giving Your Feet and Legs Some TLC

“People with peripheral neuropathy can feel like they are walking on golf balls,” Ali says. “Wearing orthotics is very effective at managing symptoms.” If you have weak leg muscles due to motor neuropathy, physical or occupational therapy, as well as braces that extend up the lower leg, can provide extra stability, Faber says. “This is especially helpful if the person has been falling,” he adds.

5. Paying Attention to Your Diet

“Eating a healthy, balanced diet can help you feel better,” Ali says. Fruits, vegetables, and plenty of fiber can keep blood sugar levels low, which is good for peripheral nerves.

6. Making Sure You Exercise

“Low-impact exercise can help with peripheral neuropathy,” Ali says. Swimming is easy on the joints and bones, and so is walking or riding a stationary bike. Weight-bearing exercises can be helpful, but get your doctor’s okay first, because multiple myeloma can weaken bones and increase your risk of fractures, Faber notes.

7. Considering Acupuncture

“I have learned from my patients that acupuncture can really help sensory neuropathy, especially when other modalities have failed,” Faber says. “I would recommend incorporating acupuncture into your treatment strategy to see if it may be beneficial.”