Strategies to Manage Neuropathy after Transplant

Summary: Many bone marrow/stem cell transplant patients experience neuropathy (neuropathy). This presentation describes the various types of neuropathy patients may experience and reviews popular treatment options.
Presenter: Kelsey Barrell MD, University of Utah
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Highlights:
Peripheral neuropathy damages nerves in the spinal that extend down through the limbs to the hands and feet. Symptoms include pain and a burning sensation, numbness and loss of sensation, or weakness and muscle wasting.
Autonomic neuropathy affects nerves that control body functions such as digestion, blood pressure and heart rate, bowel and bladder function, sexual function, urination, vision and sweating.
Several prescription and over-the-counter medications are available to treat neuropathy. Physical therapy can slow the progression of neuropathy and promote nerve regrowth.
April 2024, Part of the Virtual Celebrating a Second Chance at Life Survivorship Symposium 2024
Presentation is 40 minutes long with 19 minutes of Q & A.
Key Points:
(03:41): Neuropathy after transplant is usually related to factors that occurred prior to transplant, such as a diagnosis of multiple myeloma or amyloidosis, rather than the transplant itself.
(12:23): Certain types of chemotherapy, such as bortezomib (Velcade®) can cause painful neuropathy. Chemotherapy-induced neuropathy improves or completely resolve over time for most patients.
(17:36): Long-term use of immune suppressants can contribute to neuropathy.
(18:05): Neurologic exams subjectively measure neuropathy. A more objective measure of neuropathy is a nerve conduction study or EMG. Skin biopsies and lab results are sometimes needed to properly diagnose neuropathy.
(23:06): Exercise can improve quality of life, physical function, balance and strength, and neuropathic pain.
(26:18): A regular fitness routine is highly recommended for improving neuropathy symptoms.
(27:24): There are no proven treatments to prevent chemotherapy-induced but prescription medications are available to help with painful symptoms including duloxetine (Cymbalta), gabapentin, amitriptyline, and Pregabalin.
(28:53): There are a number of good over-the-counter agents that can help manage the pain associated with neuropathy including some that are lidocaine-based, Biofreeze®, capsaicin and CBD.
(29:35): Prescription medications that can help with neuropathy include duloxetine (Cymbalta®), gabapentin (Neurontin®) amitriptyline, and pregabalin (Lyrica®).
(31:51): Acupuncture and massage don’t change the progression of neuropathy or restore nerve growth. However, massage has been shown to help with symptoms.
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