There are a range of supportive treatments available to help deal with the symptoms and complications of myeloma, and to prevent or manage potential side effects of treatment combinations.
Read on to find out about some of the most common supportive care treatments.
Bisphosphonates are drugs that help to slow down or prevent myeloma bone disease, hypercalcaemia and bone pain.
Current national guidelines recommend all patients with symptomatic or active myeloma are on bisphosphonate treatment. There are three bisphosphonates licensed for use in the UK – sodium clodronate (Bonefos®) which is oral; and zoledronic acid (often known as Zometa®) and disodium pamidronate (Aredia®), which are both given by intravenous infusion.
Read our Infoguide about myeloma bone disease and bisphosphates.
There are many types of painkillers available to treat varying levels of pain, ranging from over-the-counter drugs such as paracetamol, to those for mild to moderate pain like co-codamol and codeine. For moderate to severe pain morphine or high-dose tramadol might be used. Nerve pain from peripheral neuropathy can be treated with drugs such as gabapentin and amitriptyline.
Another option is a TENS machine. These deliver small electrical pulses to the body via electrodes placed on the skin. This can reduce the pain signals going to the spinal cord and the brain. They may also stimulate the brain to release endorphins, which are pain killing hormones. TENS machines are not suitable for everyone, and some patients should not use them. You should ask your medical team for advice. More information can be found at www.nhs.uk.
Many myeloma patients find that meditation, visualisation, mindfulness or a combination of these can be helpful in relieving pain too. Hot water bottles and ice packs are another method that can be very effective in providing short-term pain relief.
The best way to deal with peripheral neuropathy is to reduce the dose and frequency of administration of the drug responsible, so it is important to report any symptoms as soon as possible so as to reduce the risk of permanent damage. Gently massaging the affected area with cocoa butter twice a day can also help alleviate any pain or discomfort. Nerve pain from peripheral neuropathy can be treated with drugs such as gabapentin and amitriptyline.
Radiotherapy can be used to treat areas of localised bone disease and pain. Radiotherapy is the use of high-energy radiation (usually X-rays) to kill cancer cells. It can often relieve pain more quickly than chemotherapy or painkillers and may sometimes be the initial treatment given. Download the Radiotherapy Infosheet for further information.
When myeloma bone disease occurs in the spine, fractures can develop in the bones that make up the spine – the vertebrae – causing them to collapse. Surgical intervention may be needed for vertebral compression fractures which haven’t stabilised after non-surgical treatment.
Percutaneous vertebroplasty and balloon kyphoplasty are two surgical procedures that can treat fractures of the spine in myeloma. In general, more conservative treatments for back pain will be tried first. Plates and screws can also be surgically introduced to stabilise fractured non-spinal bones. Download the Vertebral compression fractures in myeloma Infoguide for further details.
Watch this video about back pain and surgical intervention: