“I never realized how exhausting it is to do laundry,” a MyMyelomaTeam member wrote. “I keep having to stop and rest my back.”

Fatigue is a challenging and common symptom in people with multiple myeloma and other blood cancers. It can interfere with work, social activities, and daily tasks. Unlike ordinary tiredness, cancer-related fatigue doesn’t go away with rest and can be overwhelming. Sometimes, extreme fatigue is a sign that myeloma has relapsed, or returned.

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Persistent fatigue can be discouraging and severely impact energy levels, as some MyMyelomaTeam members have shared. Another member said, “Some days, just getting up to use the bathroom seemed too much.”

To learn more, MyMyelomaTeam spoke with Dr. James Hoffman, an associate professor of clinical medicine at the University of Miami Health System’s Sylvester Comprehensive Cancer Center. He specializes in plasma cell disorders, including multiple myeloma.

Here are seven common causes of fatigue — including low blood cell counts and treatments for myeloma — along with some tips to help you feel more like yourself again.

7 Causes of Fatigue in Multiple Myeloma

According to Dr. Hoffman, fatigue is the single most challenging physical effect people with multiple myeloma experience. He explained that fatigue isn’t caused by one single factor but by several different variables, making it complicated to address.

“When someone is diagnosed with cancer — certainly with multiple myeloma — there’s a lot of things that go on all at the same time,” Dr. Hoffman said. “Patients can have pain, they can have kidney trouble. Patients … will certainly have an extreme amount of anxiety or even depression.”

The physical effects of multiple myeloma and the emotional distress associated with diagnosis is compounded by doctor’s visits, new medications, blood tests, and treatment costs. “All of this is thrown at the person at the same time,” Dr. Hoffman said. “How can a person not be fatigued?”

Myeloma or its treatment often cause fatigue, and other factors can worsen it. Here are some of the top causes of fatigue with myeloma.

1. Anemia

Anemia is a shortage of red blood cells that carry oxygen throughout the body. Myeloma cells disrupt bone marrow function, which can lead to anemia. This may show up as a low red blood cell count. When the cells and tissues of the body don’t get enough oxygen, you feel fatigued.

About 60 percent to 70 percent of people with multiple myeloma have anemia at the time of diagnosis. Symptoms of anemia include rapid heartbeat, swollen legs, dizziness, headaches, chills, and shortness of breath.

2. Cytokines

Some people with multiple myeloma have high levels of cytokines. These inflammatory proteins are released by some white blood cells and function as part of the immune system. In healthy people, cytokines help fight infection. However, high levels of cytokines can cause too much inflammation in the body, which can cause fatigue.

The fatigue from cytokine release is similar to what people feel when fighting off a virus. With myeloma, the fatigue lasts much longer.

When someone has cancer, cytokines can cause cancer cells to grow and spread to other parts of the body. Cytokines can also cause bone damage in people with myeloma.

3. Pain

Pain can also cause fatigue. Many people with multiple myeloma experience bone pain or pain related to their medications. Some myeloma treatments can lead to peripheral neuropathy. This is nerve damage or inflammation in the hands or feet. Peripheral neuropathy may lead to painful sensations such as prickling, burning, or throbbing.

4. Myeloma Treatments

Fatigue is a very common side effect of cancer therapy, which can include:

• Bone marrow transplant
• Chemotherapy
• Immunomodulatory drugs
• Immunotherapy
• Monoclonal antibodies
• Proteasome inhibitors
• Radiation therapy

Fatigue can also be a side effect of opioids, which are sometimes prescribed for pain relief in people with myeloma. Opioids include drugs such as tramadol, codeine, and oxycodone.

Talk to your healthcare team about whether your myeloma therapy or symptom management drugs may be causing fatigue.

5. Medications for Other Conditions

People who take medications for other health problems may have more fatigue during treatment for multiple myeloma. This may be from the medicines themselves or due to combinations of new treatments and other drugs. Make sure all your oncology team and other healthcare providers are aware of every medication you take for each condition. This includes over-the-counter medications, like sleep aids and antihistamines, as well as nutritional supplements.

Drugs that can cause fatigue as a side effect include:

• Antibiotics — May change bowel habits and reduce how well the body absorbs nutrients
• Antidepressants — Affect hormones and brain chemicals
• Antiemetics (anti-nausea drugs) — Interfere with brain function
• Benzodiazepines — Slow down activity in the central nervous system
• Diuretics — Disrupt the body’s mineral balance
• High blood pressure medications — Impact the heart and nervous system
• Proton pump inhibitors — Lower magnesium levels in the blood
• Statins (used for high cholesterol) — May weaken muscles and slow muscle growth

6. Emotional Stress

A multiple myeloma diagnosis comes with many sources of stress. In addition to worrying about your health, you may be worried about how your diagnosis will affect your finances, work performance, and relationships. Fatigue can be caused by the stress, depression, and anxiety that may come with a diagnosis of multiple myeloma or a myeloma relapse. It’s common for insomnia to happen along with these feelings.

With a diagnosis like this, it’s important to lean on your support system. This may be your family, friends, community, or a local or online support group. It can also be helpful to seek the help of a mental health professional.

7. Lifestyle Factors

Poor nutrition, dehydration, and reduced physical activity have been linked to fatigue. People with myeloma may not get enough nutrients because their body may not be able to absorb them well. They may also experience side effects from treatment such as nausea, diarrhea, or constipation that can make it hard to eat. If you aren’t getting the nutrients and energy you need, it can cause you to feel fatigued.

Fatigue isn’t the same as regular tiredness, and sleep won’t prevent fatigue. But poor sleep can make fatigue worse.

5 Ways To Manage Myeloma Fatigue

What helps improve your myeloma fatigue often depends on what’s causing it. Researchers have identified several techniques for improving fatigue.

1. Practice Self-Compassion

Most people with myeloma experience fatigue at some point in their disease or treatment. MyMyelomaTeam members often encourage each other to have compassion for themselves during these times. “Take it easy and don’t overdo it. Your body is telling you to relax!” one member said. Another member agreed: “I would do too much and then pay for it for a couple of days.”

Fatigue and mood are closely intertwined. Research shows that mental health problems, such as anxiety and depression, can make fatigue worse. Taking care of all sides of your health is essential while living with a long-term condition like multiple myeloma. If you need help managing emotional distress, ask your doctor about seeing a mental health counselor.

2. Prioritize the Most Important Activities

Prioritizing just one or two activities each day is another strategy for managing fatigue. One member wrote, “I’m still very fatigued, but I managed to get dressed for Sunday service.” Whenever possible, do activities and chores at times when you know you’ll have more energy. Also, ask friends and family for help if you need it.

“Do things you love doing,” another MyMyelomaTeam member suggested. “It worked for me to overcome my fatigue.

3. Try To Stay Active

Members sometimes say balancing rest with gentle exercise helps manage fatigue, especially when recovering from a bone marrow transplant. “It’s very tempting to lie around or sit in the recliner,” a member wrote. “I try to walk twice daily with a nap in between.”

Healthcare providers recommend getting regular, light exercise and keeping up with daily activities. This may help combat the fatigue and stress that may come with a multiple myeloma diagnosis. One study suggested that low- to moderate-intensity exercise that activates your muscles (resistance training) or gets your heart beating faster (aerobic training) may help curb fatigue.

Your doctor can give you a referral to a physical therapist if you need help choosing exercises that are safe and right for you.

4. Practice Healthy Sleep Habits

Good sleep habits — also called sleep hygiene — can help in many ways. These practices may protect your heart health, keep your fatigue from getting worse, and improve your quality of life. Many people with cancer have trouble sleeping. Here are some tips for getting a good night’s sleep:

• Follow a consistent routine. Go to bed at the same time and get up at the same time, on weekends as well as weekdays.
• Keep your bedroom dark and at a comfortable temperature when sleeping. Try to make your bedroom a quiet and relaxing space.
• Relax with a book or a bath before going to sleep.
• Avoid caffeine, alcohol, and large meals late in the evening.
• Avoid electronics such as television, computers, or smartphones before bed.
• Get some sunlight in the morning to boost your melatonin levels and help you sleep better at night.

5. Ask Your Doctor for Help

Your cancer care team can help you find strategies to manage your fatigue. Some members have found that simple changes, like taking medication at night rather than in the morning, can help reduce drowsiness. Other members experienced more energy after being treated for anemia. Fatigue is a myeloma symptom that should be considered in your cancer treatment plan and discussed with your oncologist.

There’s no single solution that works for everyone with fatigue, Dr. Hoffman explained. “What I say to patients when they’re confronted with fatigue is, ‘Let’s fix problems that we can focus on and fix.’ Let’s get the myeloma better,” he said. “Let’s work on anxiety, let’s work on pain, let’s deal with nutrition.”

Taking a slow, steady approach to managing fatigue takes patience. But it’s usually the most effective way to see results. “As the myeloma gets better, and as you see it get better and feel better about that, fatigue can improve,” Dr. Hoffman said. “And it usually does.”

Join the Conversation

On MyMyelomaTeam, people share their experiences with multiple myeloma, get advice, and find support from others who understand.

How does fatigue affect your daily life? Let others know in the comments below.