What Is Peripheral Neuropathy?

Peripheral neuropathy results from damage to the peripheral (e.g. arms and legs) nervous system. This system sends signals between the central nervous system (the brain and spinal cord) and the rest of the body. When a myeloma patient experiences peripheral neuropathy (PN), it occurs as a change in feeling in the hands, fingers, legs, feet, toes, or lips. PN is often described as pain, numbness, tingling, or burning.

Multiple myeloma patients may experience peripheral neuropathy as a result of the disease itself or its treatments. Report symptoms to your physician, who may adjust your myeloma treatment to help manage your symptoms of peripheral neuropathy. Symptoms include:

• tingling
• burning pain
• muscle weakness
• sensitivity to touch
• prickling sensations
• sensation of cold in the feet

Types of Neuropathy

Effects on Sensory Nerves

• tingling, numbness, or pain in your hands or feet
• trouble hearing; ringing or buzzing in your ears
• weakness all over

Effects on Motor Nerves

• trouble fastening buttons.
• difficulty opening jars or feeling the shape of small objects with your hands.
• drouble walking

Treatments that Cause Neuropathy

Thalomid® (thalidomide), Velcade® (bortezomib), Ninlaro® (ixazomib), and Pomalyst® (pomalidomide) can all cause peripheral neuropathy; Revlimid® (lenalidomide) may make pre-existing neuropathy worse.

Managing the Symptoms

Before taking any of these supplements, discuss their use with your doctor.

Managing peripheral neuropathy will allow you to move more easily and safely, carry out your daily activities, and prevent unnecessary pain and discomfort. The following suggestions may help you:

• Vitamin B6, not to exceed 100 mg per day.  (More than that can be toxic to the nerves.) If you’re already taking a multi-vitamin or a B vitamin complex that includes B1, B6, B12, and folic acid, make sure that the total daily dose of B6 is nor more than 100 mg.
• Vitamin B12, at least 400 micrograms daily (can be part of the B complex vitamin)
• L-glutamine, 500 mg per day
• L-carnitine, 500 mg per day
• Alpha lipoic acid (ALA), 400-600 mg per day. ALA comes in 200-mg capsules; take one capsule with a meal. If no improvement is seen with 400mg, you can take a third capsule with food. ALA is especially effective for leg cramping associated with peripheral neuropathy. A caveat: ALA can prevent Velcade from working. To be absolutely safe, patients who are being treated with Velcade should NOT TAKE ALA the day before, the day of, and the day after a Velcade treatment. [NOTE: high-dose vitamin C and green tea can also interfere with the action of Velcade, reducing its anti-myeloma effect.]

If symptoms become more severe, your healthcare provider may recommend the following:

• pain medication or other medication for nerve pain relief
• stopping treatment for a period of time
• lowering the dose of treatment
• physical therapy