Symptom control for myeloma

Symptom control is important for everyone diagnosed with myeloma. Your doctor will see you regularly for blood tests and x-rays, and to talk to you about how the myeloma is affecting you. 

Not everyone has symptoms, and some people may only have mild symptoms. It is important to talk to your doctor and nurse about any problems you may have. These problems may be:

  • bone damage and pain
  • pressure on the spinal cord
  • high calcium levels
  • tiredness
  • anaemia and infection
  • kidney problems
  • hyperviscosity
  • blood clots
  • eating problems
  • effects on the nerves (peripheral neuropathy).

Bone damage and pain

The most common symptom of myeloma is bone pain. About 7 in 10 people (70%) have lower back or rib pain. Other bones may be affected too, such as the skull or pelvis.

Tell your doctors and nurses about any pain this causes so they can treat it. It is important to remember that cancer pain can almost always be reduced.


Pressure on the spine (spinal cord compression)

Myeloma can develop in the bones of the spine. Sometimes this can weaken the bone and put pressure on the spinal cord. This is called spinal cord compression. This can cause pain, muscle weakness, and sometimes tingling and numbness of the limbs. If the lower spine is affected, it may also affect how the bowel and bladder work.

If you have any of these symptoms, it’s very important to tell your doctor or specialist nurse straight away. It is important to have treatment as soon as possible to prevent permanent damage.

Spinal cord compression is usually treated with steroids and radiotherapy. Sometimes chemotherapy can be given to help reduce the pressure on the spinal cord. Or surgery may be needed to repair or remove the affected bone.


High calcium levels (hypercalcaemia)

Damage to the bones from myeloma can cause calcium to be released from the bones into the blood. High levels of calcium in the blood (hypercalcaemia) can make you feel sick, thirsty, drowsy, confused and unwell. It can also cause constipation. For some people, hypercalcaemia is discovered by a blood test before any symptoms develop.

Your doctor may advise you to start drinking lots of liquids. You are also likely to have a drip (intravenous infusion) of fluids into a vein in your arm, or into your central line or PICC line if you have one. This will increase the amount of liquid/fluid in your blood and help your kidneys get rid of the calcium from your body in your urine.

Your doctor may also give you a bisphosphonate drug to quickly reduce the level of calcium. The drug is given into a vein over a few hours. It brings the calcium level down over the next 2–3 days. If your calcium level starts to rise again, you may need another dose.


Tiredness

Many people with myeloma feel tired and have less energy to do the things they normally do. This may be due to anaemia, or it may be a side effect of treatment. Your body will tell you when you need to rest, although it’s important you don’t completely stop doing things.

When you do feel like doing things, try to pace yourself. Start by setting yourself goals – maybe cooking a light meal or going for a short walk. Keeping a treatment diary of when you’re most tired can help you record your energy levels and plan activities for when you’re likely to feel stronger.


Anaemia and infection

Anaemia is a low number of red blood cells. It is a common symptom of myeloma. It can make you feel tired and breathless. Myeloma can reduce the number of red blood cells made in the bone marrow. Or sometimes anaemia can be a side effect of treatment.

Your doctor may suggest that you have a blood transfusion. The blood will be given into a vein in your arm or through your central line or PICC line if you have one. If you have kidney problems (see opposite), your doctor may suggest you have a drug called erythropoietin (EPO) instead of a blood transfusion. Erythropoietin is normally given by an injection under the skin (subcutaneously).

Myeloma and some treatments can also affect the number of white blood cells in your blood. These are the cells that fight infection. Your doctor or nurse will talk to you about infection and show you how to check your temperature. Your doctor may prescribe you drugs to help prevent an infection (prophylactic drugs). They may also advise you to have vaccines such as the flu vaccine.


Kidney problems

The paraprotein and light chains produced in myeloma can block the tubes in the kidneys and stop them filtering waste products from your blood properly. A build-up of calcium in the bloodstream from damaged bones can also cause kidney problems.

If your kidneys are affected, you will have extra fluids through a drip (infusion). This encourages your body to flush the waste products out of your kidneys in your urine. You can help prevent kidney problems by drinking plenty of fluids each day – three litres (five pints) or more if you can. You should check with your doctor or nurse before taking drugs called non-steroidal anti-inflammatory drugs (such as ibuprofen), as these can cause kidney problems.

Treatment for myeloma will usually reduce the amount of paraprotein in the blood and help with kidney problems.

Rarely, kidney damage is severe and the kidneys stop working altogether. This is known as kidney failure (renal failure). If you have kidney failure, blood is not filtered properly and no urine is produced. Excess fluid then begins to build up in the body. If this happens, you will need to have your blood artificially filtered, which is called kidney dialysis.

You can contact our cancer support specialists on 0808 808 00 00 to talk about dialysis.


Hyperviscosity syndrome

Rarely, myeloma causes a very high level of paraprotein in the blood. This means the blood can become thicker than normal. This is called hyperviscosity. It can cause symptoms such as headaches, blurred vision, abnormal bleeding, confusion or dizziness.

You may need plasma exchange (plasmapheresis). This is a procedure that removes the excess paraproteins from the blood.


Blood clots

Myeloma can increase your risk of developing a blood clot (thrombosis), and some treatments may increase this risk further. A blood clot may cause symptoms such as:

  • pain, redness and swelling in a leg
  • breathlessness and chest pain.

Blood clots can be very serious, so it’s important to tell your doctor straight away if you have any of these symptoms. Most clots can be successfully treated with drugs to thin the blood.

Your doctor or nurse can give you more information about blood clots.


Eating problems

Myeloma and some myeloma treatments can cause problems with sickness and loss of appetite.

Drugs such as painkillers and antibiotics can make you feel sick. Physical problems like constipation or high calcium levels can also make you feel sick. There are several treatments to help prevent and control sickness. Your doctor can prescribe anti-sickness (anti-emetic) drugs for you. Let them know if your anti-sickness drugs are not helping, as there are different types you can take.

We have more information and tips on what you can do to control sickness and vomiting.

If you have a poor appetite, try to eat little amounts as often as possible. Keep snacks handy to eat whenever you can, such as nuts, grated cheese or dried fruit.

It’s important to try to eat well during your treatment. If you’re having problems, ask your nurse for advice. You can also ask to see a dietitian. You can add extra energy and protein to your diet with everyday foods or by using food supplements.


Effects on the nerves (peripheral neuropathy)

Myeloma and its treatment can affect the nerves in your hands or feet. This can cause tingling, numbness, or a feeling like pins and needles. This is called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.

It’s important to let your doctor or nurse know if this happens. If it is caused by your treatment, it may need to be changed. Usually peripheral neuropathy gets better when treatment is over, but it can sometimes be permanent.

Back to Symptom control

Bone damage and pain

Bone pain is the most common symptom of myeloma. It can be controlled with painkilling drugs, bisphosphonates, radiotherapy or surgery.