Supportive care treatments

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

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.

Pain relief

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.

Get more information by downloading the Pain and myeloma Infoguide and the Peripheral neuropathy Infosheet.

Radiotherapy

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.

Surgical intervention

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:

Prevention and management of side effects

The drugs used to treat myeloma can cause some side effects. Each drug has its own set of side effects but can produce different reactions in different patients. Some patients will have few side effects, others will have more. Most side effects are short-term, can be avoided, managed well and usually resolve once treatment is finished.

These are some of the most common treatments and their side effects:

• Chemotherapy: nausea, infection, diarrhoea, anaemia, fatigue, sore mouth and hair thinning or loss
• Steroids: insomnia, stomach pain, increased blood sugar, increased risk of infection, increased appetite, shaky/trembling fingers, mood swings and muscle weakness
• Thalidomide: birth defects if taken during pregnancy, drowsiness, constipation, peripheral neuropathy, blood clots
• Lenalidomide (Revlimid®): birth defects if taken during pregnancy, anaemia, fatigue, decrease in blood counts, increased risk of infection, blood clots, peripheral neuropathy
• Bortezomib (Velcade®): peripheral neuropathy, nausea, constipation, anaemia, fatigue and loss of appetite

Side effects can be prevented or managed with dosing adjustments and a range of supportive treatments, such as:

• Anti-sickness (anti-emetics) tablets can help prevent nausea and vomiting
• Anti-diarrhoea, laxative and antacid tablets can help with gastrointestinal problems
• Anti-clotting drugs such as Warfarin™ or low-dose (75mg) aspirin can prevent clots forming
• Blood transfusions or treatment with a drug called erythropoietin (EPO) can help boost your red cell count if you become anaemic
• Antibiotics and antivirals can prevent or treat infection

Supplements and herbal remedies

Unless your healthcare team has told you that you should take specific supplements or vitamins, no supplements are recommended for myeloma patients. There is no clear clinical evidence that supplements, natural medicines or herbal remedies are of any benefit to patients, either as anti-myeloma treatment or as a way of alleviating side effects.

Although it’s normal to want to do whatever you can to help support your myeloma treatment, supplements or herbal medicines that have not been prescribed by your haematologist have the potential to cause problems when taken alongside your prescribed treatment.

It is extremely important that you speak to your haematologist before taking any kind of supplement or alternative treatment that they have not prescribed, including herbal, traditional or natural medicines and remedies, and vitamins or wellbeing supplements, to ensure it is safe to do so and will not have any harmful effects when taken alongside your prescribed treatment.