Peripheral Neuropathy and Multiple Myeloma: Not Just Feet and Hands

BY PAUL KLEUTGHEN

Just about all myeloma patients are already members of the “Unhappy Feet and Hands” club,  but there is much more to peripheral neuropathy than the standard "How are the hand and feet doing?" our physician asks during routine visits.

There is plenty of reading material to be found relating to peripheral neuropathy (PN) and almost as many opinions as to what works in dealing with peripheral neuropathy.

A nice, single summary on peripheral neuropathy put together by the Myeloma Foundation of Australia is an online brochure that includes a wealth of information about what PN is, why it is prevalent in MM patients, the different kinds of PN there are and how to be aware of those differences, management and self-management strategies. Here are some excerpts from the brochure:

How does the disease process of myeloma cause peripheral neuropathy? The disease process of myeloma can cause peripheral neuropathy in a few ways. It is thought that the myeloma protein (paraprotein) produced by the malignant plasma cells, can cause direct damage to the nerve cells, resulting in symptoms of neuropathy. Sometimes, myeloma may be complicated by a condition called amyloidosis (light chain deposition) which can cause peripheral neuropathy. In some people, high levels of paraprotein can lead to thickening of the blood (hyperviscosity) and cause sluggish blood flow, which may also lead to symptoms of peripheral neuropathy. Peripheral nerves, which leave the spinal cord, may also be damaged from a fractured vertebra caused by myeloma bone disease. Other factors causing peripheral neuropathy may include weight loss, metabolic or toxic factors related to the myeloma. Peripheral neuropathy caused by the myeloma disease process should improve with treatment that controls the myeloma.

Are there other factors that may worsen peripheral neuropathy?

• Smoking – interferes with peripheral circulation and nerves so consider stopping. Ask the GP or practice nurse for advice and/or local support.
• Diabetes – Monitor blood sugar levels carefully. Chronically elevated blood sugar levels can damage the peripheral circulation and nerves.
• Alcohol – Chronic alcohol abuse also frequently leads to nutritional deficiencies (including B12, thiamine, and folate) that contribute to the development of peripheral neuropathy. Speak to the doctor about safely reducing alcohol intake if it is a problem.
• Infections – Some bacteria and viruses such as shingles (see box 1) can cause peripheral neuropathy.
• Other Medications – Some chemotherapies and other types of drugs not used to treat cancer can also cause peripheral neuropathy.

Maintain good general health to create a good environment for nerves to repair:

• Exercise to improve blood circulation and the oxygen supply to the nerves
• Eat a well-balanced diet using freshly prepared ingredients. Avoid highly processed foods where possible. A balanced diet with ample sources of vitamins B6, B12, vitamin D, folate and healthy fats helps protect the nervous system. Aim to include lots of fresh fruits, vegetables, whole grains and fish rich in omega 3 fatty acids in the diet
• Drink plenty of water and other non-alcoholic drinks
• It is strongly recommended to give up smoking. Smoking constricts the blood vessels that supply nutrients to the peripheral nerves and this can make symptoms worse • Avoid excessive amounts of sugar and alcohol
• Chronically elevated blood sugar levels also cause damage to peripheral circulation and nerves. Steroid medications such as dexamethasone and prednisolone used in myeloma treatment regimens can elevate blood sugar therefore the blood sugar level should be monitored by the treating team regularly

Of special interest is a “self-monitoring” questionnaire (page 15 of the brochure) that is suggested to be filled out every week to keep track of progression of peripheral neuropathy. Bringing this completed questionnaire along on our visits to our physicians will be a good tool to help us talk to our providers about something we live with every day, feel every day, but that may be set aside a little as we discuss light chains, IFE’s, microglobulins, and so on. This questionnaire will also help us focus on those different kinds of PN that we need to pay attention to. There is also a nice list of proactive safety measures to consider to avoid accidents resulting from progressive lack of sensation and loss of muscle strength (page 27) resulting from PN.