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What Can Myeloma Patients Do for Neuropathy?

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Published on December 19, 2017

How can myeloma patients combat the pain and numbness caused by neuropathy? Are there alternative treatment regimens? Our panel of experts, including Dr. Frits van Rhee, Dr. Guido Tricot, Dr. Faith Davies and Dr. Gareth Morgan, joins us at the UAMS Myeloma Institute to share ways to work with your medical team to help reduce the intensity of drug side effects. They also provide at-home steps to take for symptom management. Watch for their expert tips for dealing with this commom side effect of myeloma treatment.

This town meeting is sponsored by Amgen, Janssen Pharmaceuticals and Takeda Oncology. It is produced by Patient Power in partnership with the UAMS Myeloma Institute.

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University of Arkansas for Medical Sciences Myeloma Center

Transcript | What Can Myeloma Patients Do for Neuropathy?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Jeff Folloder:

Let’s talk about neuropathy for just a moment. Eileen is experiencing neuropathy in her feet. She believes that it’s due to the lenalidomide (Revlimid) that she’s taking. She’s been on several different doses. Is there any use in seeing a neurologist, or is this just something she’s going to have to live with? 

Dr. van Rhee:      

She can see a neurologist if there’s truly doubt whether it’s due to the Revlimid. Revlimid has a fairlylow incidence of neuropathy, but it does happen.

Sometimes stopping the drug is the most important thing. Then there are other things one can do. One can take drugs like gabapentin (Neurontin), there’s pregabalin (Lyrica), there’s duloxetine (Cymbalta). There is sometimes vitamin supplementation that we use. So there are various other measures to support to try and deal with the symptoms. 

Jeff Folloder:     

Anyone else want to add something about neuropathy?

Dr. Tricot:            

There’s a difference between the proteasome-induced neuropathy and the emit-related neuropathy. If you take thalidomide (Thalomid) or Revlimid, you take it almost every day or three weeks out of four. Typically, it’s not painful. It’s mainly tingling and decreased sensitivity.

It’s very difficult to get that improved with any type of medication. The proteasome inhibitors, they typically are cyclic. You get a dose of Velcade (bortezomib), it gets worse and then it gets better again; you get another dose, it gets worse again. So it’s more cyclic, and it’s typically painful. It’s in those patients that the gabapentin and the other drugs work much better. But for just tingling and numbness, it’s very difficult to have that improved by any way.

The major thing that people need to remember is that it’s extremely important that you can get those drugs as long as possible. So it’s better to give lower doses that you can give for a longer period of time or less frequent dosing that you can give for a longer period of time, than trying to give the highest possible dose and very quickly run into problems, saying you have to stop it.

Dr. van Rhee:      

I think the other point to make is that there are two classes, two bold classes of drugs; the proteasome inhibitors and what we call immunomodulatory drugs, drugs like thalidomide,Revlimid. If you get neuropathy due to thalidomide, it doesn’t necessarily mean that you’re going to get neuropathy with a different class of drugs. It’s a different mechanism.

Dr. Davies:            

I just wanted to add one quick thing, as well. It sounds very stupid but I think good foot care is also important, so making sure you look after your nails and get them well maintained. Many people also find that a number of alternative therapies are quite useful for neuropathy. So be it aroma therapy, massage therapy and so on; many people have actually found that quite helpful, too.

Jeff Folloder:     

So mani-pedis and massages for everyone?

Dr. Davies:            

Sounds very reasonable.

Sleep with socks on, as well, because that is one of the symptoms is at night the temperature change. 

Dr. Morgan:         

We need to finish this up. Make sure it is peripheral neuropathy; make sure it’s not one of the other neuropathies. There’s mononeuritis, multiplex; not everything on treatment is peripheral neuropathy. Make sure of the drugs you’re on; it’s often a drug side effect. Make sure it’s not due to the underlying disease process; make sure there’s not another disease process going on. Do all of that before getting into the treatment, because you can go down the garden path of treating something that isn’t there to start with. So, get a good diagnosis before moving through all of those things.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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