Controlling symptoms of myeloma
This page is about controlling symptoms of myeloma. You can find the following information
Controlling symptoms of myeloma
If you are having troublesome symptoms from your myeloma, you will have treatment to try to reduce and control them. If you have a low red blood cell level (anaemia) you may have blood transfusions. You will have antibiotics if you get an infection.
If you have breaks (fractures) in the bones of the spine your doctor may refer you for specialist surgical techniques that inject special cement into the spine to strengthen it and reduce pain. The surgical techniques are called vertebroplasty and balloon kyphoplasty.
If you have numbness or a change in sensation in your fingers or toes caused by myeloma treatment, your doctor may prescribe medicines such as low dose anti depressant drugs or low dose anti epileptic drugs.
Sometimes proteins produced by the myeloma cells can thicken the blood (hyperviscosity), which can clog up small blood vessels and cause confusion, dizziness or stroke like symptoms. If you have this, you may have a procedure called plasmapharesis which removes the excess protein from the blood. The abnormal protein can also cause kidney damage. To try to prevent this it is important to drink 2 to 3 litres a day.
Palliative care teams
These teams include doctors, nurses and other health professionals who specialise in controlling symptoms of diseases, especially cancer. You may be referred to a palliative care team at any stage of your illness if you have pain or other symptoms that are difficult to control. The team will advise on treatments or drugs that can control your symptoms.
You can view and print the quick guides for all the pages in the treating myeloma section.
Anaemia means that you have a low red blood cell count. Red blood cells carry oxygen around the body. If the level of red blood cells is low your body cells don't have a good enough supply of oxygen to work properly. So you feel tired (fatigued) and may also feel breathless. This is quite common in people with myeloma, particularly if your kidneys are not working very well. Healthy kidneys make a hormone called erythropoietin (EPO) which helps the bone marrow to make red blood cells. You may have blood transfusions to increase your red cell count.
If your anaemia is severe and keeps coming back despite blood transfusions, and if your kidneys are not working well, your doctor may suggest erythropoietin treatment. You have it as an injection under the skin, usually in the leg or in the tummy (abdomen).
Fatigue means tiredness and lack of energy. Fatigue is a common symptom of myeloma and affects everyone differently. It can be due to anaemia or may be a side effect of treatment. It may be mild or it can impact greatly on your daily life. You may have a poor memory and feel unable to concentrate properly. You may have low moods and feel irritable. And you may feel weak and have difficulty sleeping.
Your doctor can assess and treat any underlying cause of your fatigue. If cancer treatment, such as chemotherapy or biological therapy, is making your fatigue worse this should improve once your treatment finishes.
If you feel very tired there are ways of dealing with this and it can help to carefully plan your daily activities. You can find helpful tips in the section about managing cancer fatigue.
Frequent infections are another common problem with myeloma. You may need to have treatment with antibiotics. If you have a low white blood cell count, you may need to go into hospital when you have an infection so that you can have the antibiotics into your bloodstream through a drip.
Doctors recommend that people with myeloma have vaccinations to protect against flu and chest infections. Your doctor or specialist nurse can advise you about this.
Myeloma often causes damage to areas of bone. This can weaken the bone in those places and may cause pain. Bisphosphonate drugs can help to reduce this problem. These drugs bind to areas where bone has been destroyed. This slows down the damage caused by the myeloma cells. Two main types of bisphosphonates are used to treat myeloma patients
- Pamidronate (Aredia) and zoledronic acid (Zometa) are given as a drip into a vein once a month
- Sodium clodronate (Bonefos) is taken as tablets twice a day
Radiotherapy can also strengthen areas of bone damage and reduce pain. There is a limit to the amount of radiotherapy that you can have to any part of your body. So, if you have pain in an area where you have already had radiotherapy, you may not be able to have this treatment again.
Even with bisphosphonate treatment and radiotherapy, bone pain may still be a problem for some people with myeloma. A wide range of painkillers (analgesics) can be used to treat pain.
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Some people with myeloma have breaks (fractures) of the spinal bones. Fractures caused by myeloma put pressure on the spine and can be very painful. The bones of your spine (vertebrae) can collapse, making the spine change shape. It can become very curved – doctors call this kyphosis. So you may lose height. Your doctor may refer you for a specialist non invasive surgical technique called vertebroplasty or balloon kyphoplasty.
Vertebroplasty involves injecting special cement into the spine to strengthen it and reduce pain. Balloon kyphoplasty is similar but little balloons are put into the spine. They are slowly inflated so that the spinal bones go back to as near normal height as possible. The doctor injects special cement into the space created by the balloon. This can strengthen the bone, relieve pain and restore some height.
Other treatments for spinal fractures include wearing a brace or surgery. You may also have radiotherapy.
Tingling, numbness or a different sensation in your fingers and toes can happen for several reasons in people with myeloma. These symptoms can be a sign of damage to the nerves, and is called peripheral neuropathy. It may be due to the myeloma itself or may be caused by other medical conditions. Or it may develop, or get worse, as a side effect of some chemotherapy treatments (such as vincristine) or biological therapies (such as thalidomide or bortezomib).
Peripheral neuropathy can cause nerve pain, loss of sensation, a feeling of tightness or burning and may also affect your balance. It most commonly affects your feet and hands, but it may also affect nerves elsewhere in your body. Your doctor and nurses will be looking for signs of peripheral neuropathy during your treatment. You should always let your doctor or nurse know if you notice any new symptoms.
Your doctor can give you medicine to help with nerve pain. Doctors often use lower doses of anti depressant drugs and drugs that prevent fits (anti epileptics), as well as painkillers such as paracetamol. A cream called capsaicin may also help some people.
Peripheral neuropathy from treatment is often temporary and improves once treatment stops or the dose of the drug is reduced. But unfortunately for some people the effects can be permanent.
Read more about peripheral neuropathy after treatment.
The abnormal protein (paraprotein) made by myeloma cells can damage the small tubes in the kidney that filter urine. High levels of calcium in the blood, due to myeloma bone disease, may also cause kidney damage. Some drugs such as non steroidal anti inflammatory drugs (NSAIDS) may also affect the kidneys, and so your doctor may advise you not to take these. Dehydration can make the situation worse, so it is important to drink as much as you can. Doctors generally encourage patients with myeloma to drink 2 to 3 litres each day.
The symptoms of kidney damage can include thirst, loss of appetite, feeling and being sick, and either passing much more or much less urine than usual. You may also have swollen ankles or breathing problems. It is very important to let your doctor or nurse know of any new symptoms as soon as you notice them. They will monitor how well your kidneys are working. This means that they are likely to notice early changes in how your kidneys are working before you have any symptoms. If you do get kidney damage it is often improved with fluids and other treatments. The main treatment is treating the myeloma itself, because this is the cause of the kidney damage. You may need to see a kidney specialist. Kidney specialists are called renal doctors.
Dizziness or stroke symptoms can happen with advanced myeloma. These symptoms are caused by the increased amounts of protein produced by myeloma cells (paraprotein). The extra protein in the blood makes the blood thicker and it circulates around the body more slowly than normal. This is called hyperviscosity. It can clog up small blood vessels and cause symptoms such as confusion, dizziness, headaches and stroke like symptoms. This is due to the thickened blood blocking very small blood vessels in the brain.
A procedure known as plasmapheresis (or plasma exchange) quickly removes the excess protein from the blood. This is a similar process to having a stem cell collection. Your nurse or technician connects you to the plasmapheresis machine by 2 tubes similar to the infusion tubes used for drips. One tube takes your blood into the machine and the other gives it back into your vein. The machine separates the blood cells from the blood plasma (the liquid part of the blood). The protein is in the plasma. The machine replaces the plasma with a solution that is very similar to normal plasma. It is given back to you with your blood cells. This process takes 2 to 3 hours. You can have this treatment more than once if you need to. Your doctor will closely monitor your protein levels.
People with myeloma can also be more likely to develop blood clots. This can be a side effect of some myeloma treatments. Or it may be caused by infection or by not moving around very much. If you are at a higher than normal risk of developing blood clots you may have blood thinning medicines such as warfarin.
These are teams of doctors, nurses and other health professionals who specialise in controlling symptoms of diseases, especially cancer. You may be referred to the palliative care team at any stage of your illness if you have pain or other symptoms that are difficult to control. The team will advise on treatments or drugs that can control your symptoms. They may be able to visit you in your home.
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