Bone pain from multiple myeloma: Here's how the symptoms can be treated

Health experts reveal why people with multiple myeloma suffer from bone pain and share treatment tips on how the symptoms can be treated

Multiple myeloma is a cancer of plasma cells in bone marrow and as per reports, about 60 percent of patients with multiple myeloma have bone pain at the time of diagnosis. Patients with multiple myeloma suffer from bone pains because the cancerous plasma cells cause damage to the bones as these cells cause an imbalance between bone resorption and new bone formation, leading to weakening of bones, which causes bone pains.

Bone pain from multiple myeloma: Here's how the symptoms can be treated (Photo by Twitter/CHENNashville )

In an interview with HT Lifestyle, Dr Satish Kumar, Consultant Hematologist and Hemato–Oncologist at Manipal Hospital in Yeshwanthpur, shared, “These bones are prone to fractures, which increases pain further. The bone pain can occur at any part of body, but is most commonly felt in back (spine), ribs and hips. Pain is more often induced by movement and is less common at night during sleep though can occur with change of position. The bone fragments of vertebrae can also impinge on the nerves or spinal cord causing severe neuralgic pains.”

Dr Rajeev Vijayakumar, HOD and Senior Consultant Medical Oncology, Hemato oncology and BMT Physician at BGS Gleneagles Global Hospital in Bengaluru, explained, “My’oh’ Ma (Myeloma) - all that glitters is not gold. Similarly, all back pains in adults is not due to disc problems or arthritis. Myeloma aka multiple myeloma is a condition which causes chronic worsening back pain, often misdiagnosed as a sprain. However , in the hands of an astute physician, this condition can get diagnosed quickly often leading to very gratifying pain relief. Plasma cells are responsible for generating the antibodies which provide us immunity. Myeloma is a cancer of the plasma cells and causes pain by various mechanisms.”

He elaborated, “The rapidly expanding plasma cells in the marrow can cause a dull boring pain in the large bones and spine. Myeloma induces breakdown of the bone (Bone lysis) leading to reduced bone strength hence, pain. It can lead to fractures and compression of the spinal bones (Vertebra). Fractures can also occur in any bone involved by the disease. A deposition of the cells close to a nerve or the spinal cord can cause compression and severe shooting pain.”

Talking about management of bony pains in multiple myeloma, Dr Satish Kumar, suggested:

• Primary treatment of multiple myeloma with 3 or 4 non-chemotherapy drugs simultaneously to destroy the cancerous plasma cells
• Pain medications - Drugs like paracetamol and tramadol are given to alleviate pain. If pain on significant, opioid drugs like morphine tablets or fentanyl patches may be used. Pain killers (NSAID’s), like ibuprofen or diclofenac are avoided since they can cause or worsen kidney function.
• Drugs to strengthen the bones – Bisphosphonates or denosumab are given to all patients with multiple myeloma and bone disease. These drugs will decrease bone resorption, strengthen the bones and decrease the risk of fractures. These drugs are given every month for about an year followed by once in 2 to 3 months for total duration of at least 2 years.
• Radiation therapy - Is given to patients with myeloma, to shrink the myeloma tumours, when present outside the bones and is pressing on nerves or spinal cord causing pain or paralysis
• Surgery – In some cases, surgery may have to be done t stabilize the weak bones. If there is collapse of vertebra in the backbone, and patient has severe back pain, a procedure called vertebroplasty is done where bone cement is injected into the collapsed vertebrae. This gives significant pain relief to such patients.

Adding to the list of tips on treating myeloma induced pain, Dr Rajeev Vijayakumar, recommended:

1. Analgesics – NSAIDS like Paracetamol or Opioids like Tramadol, morphine, Fentanyl.
2. Radiation to the affected bone, paraspinal mass. Helps relieve pain in a matter of 3-5 days.
3. Corticosteroids – Helps immediate pain relief over a few hours. It is also one of the mainstay therapies for myeloma.
4. Chemotherapy – Unlike its toxic counterparts, chemo for myeloma is fairly simple with minimal side effects. It provides a steady and longlasting pain relief, brought about by reducing quantum of disease.
5. Zoledronic acid – It is a 15 min iv infusion drug given once in 4 weeks which builds back the destroyed bone and strengthens it.

Like in every-other disease, patient education plays a vital role in getting quick and sustained response to multiple myeloma.