Case Study: Comprehensive Long-Term Management of Chemotherapy-Induced Peripheral Neuropathy in Multiple Myeloma Survivors

Background and Introduction

Bortezomib (Velcade), a widely used proteasome inhibitor in the treatment of multiple myeloma, is highly effective in controlling cancer progression but often leads to a significant adverse effect: chemotherapy-induced peripheral neuropathy (CIPN). CIPN presents as sensory loss, pain, and motor dysfunction, severely impacting the quality of life and independence of cancer survivors. This case study highlights the integrative, long-term management of CIPN in a multiple myeloma survivor, demonstrating how a holistic approach can restore function, reduce pain, and improve overall well-being.

Patient Case Overview

  • Patient: Male, 65 years old

  • Cancer Type: Multiple Myeloma (Stage II)

  • Chemotherapy Regimen: Bortezomib (Velcade) and Dexamethasone, completed 2 years ago

  • Current Status: Cancer-free, in remission for 18 months

  • Onset of Neuropathy: Symptoms began during the first cycle of chemotherapy and progressively worsened over time

  • Symptoms: Severe pain, burning sensations, and numbness in the feet and lower legs, with some involvement in the hands, leading to significant difficulty walking and maintaining balance

  • Impact on Life: Limited mobility, reliance on a cane, reduced ability to perform daily tasks independently, and decreased participation in social activities

Initial Presentation and Assessment

The patient presented with chronic, debilitating CIPN, severely affecting his mobility and quality of life. A comprehensive assessment revealed:

Symptom Severity: 8/10 on the pain scale

Areas of Involvement: Feet, lower legs, and some involvement in the hands

Physical Findings:

  • Sensory Loss: Profound loss of sensation in the feet and lower legs, with impaired ability to perceive temperature and pain, accompanied by a persistent burning sensation indicative of small fiber neuropathy

  • Motor Dysfunction: Significant muscle weakness in the lower extremities, notably in dorsiflexion and plantarflexion of the ankles, contributing to gait instability and increased reliance on a cane

  • Reflexes: Absent Achilles tendon reflexes and markedly diminished knee reflexes, suggesting severe peripheral nerve damage

  • Balance and Gait: Unsteady, broad-based gait with the inability to perform tandem walking or stand on one leg without support, underscoring severe proprioceptive deficits

Medical History: Hypertension, well-controlled with medication, and prior corticosteroid use during cancer treatment, which may have contributed to muscle weakness

Holistic Treatment at Advanced Nerve and Health Center

The treatment strategy aimed at alleviating pain, restoring nerve function, and improving overall mobility through an integrative, non-invasive approach:

Class IV Laser Therapy

  • Objective: Alleviate severe neuropathic pain, stimulate nerve regeneration, and improve sensory and motor function

  • Procedure: Intensive laser therapy administered twice weekly for 16 weeks, utilizing high-energy lasers (810 nm and 980 nm) delivering 7000 joules per treatment area. The therapy targeted both superficial and deep tissues to promote cellular repair and reduce inflammation

Pulsed Electromagnetic Field (PEMF) Therapy

  • Objective: Enhance nerve healing, reduce chronic pain, and improve circulation

  • Procedure: High-frequency PEMF sessions conducted twice weekly, tailored to address severe sensory and motor dysfunction. The therapy focused on enhancing microcirculation, reducing oxidative stress, and promoting angiogenesis, all critical for nerve repair

Neurolight Therapy

  • Objective: Support ongoing nerve repair, maintain circulation, and reinforce the effects of in-clinic treatments

  • Procedure: Daily at-home infrared therapy using a Neurolight unit to improve peripheral blood flow, enhance tissue oxygenation, and provide consistent support for nerve healing

Nutritional Support and Lifestyle Modification

  • Objective: Minimize systemic inflammation, support nerve recovery, and improve overall health

  • Plan: Implemented a diet rich in anti-inflammatory foods, including omega-3 fatty acids, antioxidants, and nutrient-dense vegetables. Supplementation with alpha-lipoic acid, coenzyme Q10, and curcumin was used to reduce oxidative stress and support mitochondrial function in nerve cells


Treatment Outcomes and Patient Progress

After 16 weeks of intensive, multidisciplinary treatment, the patient reported significant improvements:

  • Pain and Sensory Symptoms: Pain levels reduced from 8/10 to 2/10, with substantial reduction in burning sensations and numbness in the feet and lower legs. Partial sensation, particularly in temperature and pain detection, was regained, enhancing safety and comfort

  • Motor Function: Noticeable improvements in walking ability and a reduced reliance on a cane. Increased muscle strength in the lower extremities contributed to more confident and stable movement

  • Balance and Gait: Improved balance and a more stable gait, with increased ability to perform balance tasks independently. The patient felt more secure in daily activities, significantly reducing the risk of falls

  • Quality of Life: Enhanced independence in daily activities, greater engagement in social functions, and a more positive outlook on life post-cancer treatment

Discussion and Implications for Oncology Practice

CIPN is a prevalent and often debilitating side effect of Bortezomib in multiple myeloma patients, significantly affecting survivorship quality. Effective management of CIPN is crucial for improving long-term outcomes, as it enables patients to regain independence and maintain an active lifestyle. This case underscores the value of a holistic approach to neuropathy treatment, integrating non-invasive therapies with physical rehabilitation and psychosocial support to address the multifaceted needs of CIPN patients.

Benefits of Collaboration

  • Comprehensive Care: Our integrative approach aligns with the goals of long-term survivorship by providing complementary, non-invasive care that supports the overall health and well-being of cancer survivors

  • Improved Patient Satisfaction: Effective CIPN management leads to significant improvements in quality of life, enhancing overall satisfaction with cancer treatment outcomes and long-term care

Conclusion

The Advanced Nerve and Health Center specializes in treating chronic CIPN, particularly in multiple myeloma survivors. Our evidence-based, integrative approach helps patients regain mobility, reduce pain, and restore independence, significantly improving their quality of life post-cancer treatment. Through personalized, comprehensive care, we empower cancer survivors to lead fulfilling lives well beyond their cancer journey.