Much is written about diabetic neuropathy. Diabetic neuropathy is best treated by prevention; that is keeping blood sugar as near to normal as possible.

Unfortunately myeloma associated neuropathy may be unavoidable. The disease itself can cause neuropathy. Most of the standard treatments, most notably thalidomide, have neuropathy as a significant side effect. A certain degree of neuropathy is unavoidable with even low dose thalidomide.

Many patients have chosen to discontinue treatments that were effective against the myeloma because the neuropathy had so adversely affected their quality of life.

Most of the drug treatments used for neuropathy in myeloma have been used originally with varying degrees of success in diabetics.

Drug treatments include:

• Tricyclic antidepressants
• amitriptyline (brand name Elavil)
  
• nortriptyline (brand name Pamelor and others)
  

• Anticonvulsants
• gabapentin (brand name Neurontin)
• pregabalin (brand name Lyrica)
• topiramate (brand name Topamax)

• Selective serotonin-norepinephrine reuptake inhibitors (SSRIs)
• venlafaxene (brand name Effexor)
• duloxetine (brand name Cymbalta)

• Opiods or opiod-like medications
• tramadol (brand name Ultram)
• oxycodone (many brands; Percocet is oxycodone/acetaminophen combo)

These drugs can be used alone or in combimation and are prescription only. Many have side effects of their own.

Richard has tried neurontin and pregabalin. The pregabalin was somewhat helpful, but caused significant swelling in his lower legs, so he stopped it. Currently he takes long acting oxycodone twice a day which does help. It's main side effect is constipation.

Vitamin and mineral supplements have also been proposed for neuropathy. The following is a regimen proposed by one of the nationally known myeloma treatment centers.

(apologies for the small print; you can find a larger version here )



The next post will discuss "alternative" treatments.