How to Manage Multiple Myeloma Pain

What causes multiple myeloma pain?

Myeloma bone disease causes bone to break down faster than it can be repaired. This can lead to painful conditions like:

  • Osteopenia. This means thin bones. This can cause a dull general pain or a more local ache.
  • Lytic lesions. This is the loss of pockets of bone, which can also cause dull overall aches or pain at a specific place.
  • Bone fractures. As bones thin, they break more easily.
  • Spinal compression. if a vertebra in your spine breaks, the damaged bone can press on your spinal cord and cause sharp, shooting pains in your limbs.
  • Malignant spinal compression. A tumor pressing on your spinal cord can also cause back pain that slowly gets worse. It might feel like a tight band around your chest and belly. It can also move down to your legs and bottom.
  • Spinal collapse. More than one broken vertebrae can cause your spinal column to collapse. It could be a dull ache, a sharp pain in your ribs and belly, or a shooting pain that moves up and down your leg.
  • Kyphosis. If your spine collapses, you can get a curve in your back that leads to chronic back pain.
  • Hypercalcemia. As bone is destroyed, your system gets swamped with calcium. It can lead to pain and problems like constipation and vomiting.
  • Peripheral neuropathy. Myeloma or its treatments can damage your nerves and lead to this condition, which causes tingling, numbness, and sometimes a sharp burning or jabbing pain in various body parts.

Where Does It Hurt?

Multiple myeloma can cause pain in any bone, but you’ll most likely feel it in your:

  • Back
  • Hips
  • Pelvis
  • Skull
  • Belly
  • Chest
  • Arms
  • Legs
  • Jaw
  • Teeth

Medicines to Treat Multiple Myeloma Pain

Medications are one way to help you handle pain, and there are many to choose from. Your doctor will talk with you about when and how often to take pain medicine. Always ask your doctor before you take anything, even those you can get from the drugstore.

Drugs that treat multiple myeloma pain include:

  • Over-the-counter pain relievers like acetaminophen, aspirin, ibuprofen, and naproxen. They help with mild to moderate pain.
  • Opioids. These are stronger pain-fighting medicines that you get with a doctor's prescription. Morphine is one of the most common for multiple myeloma pain. Other opioids include codeine, fentanyl, hydrocodone, hydromorphone, methadone, and oxycodone. These come in pills, patches, lozenges, and sprays. If used for a long time, they can lead to dependence, so be sure to follow your doctor's instructions for taking them.
  • Antidepressants. Some of these drugs, such as amitriptyline, duloxetine, and nortriptyline, can help treat nerve pain, called neuropathy, that often comes with multiple myeloma.
  • Anticonvulsants. Medications like gabapentin (Neurontin), pregabalin (Lyrica), and topiramate (Topamax) also treat nerve pain.
  • Corticosteroids. These medicines, like dexamethasone and prednisone, can help fight tumors and control inflammation.
  • Anesthetics. Lidocaine skin patches, ointments, and gels can numb pain in specific areas. Your doctor can also inject anesthetic or anti-inflammatory drugs near a painful spot or nerve center, which is called a nerve block.

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Other Treatments

Procedures and devices used to treat multiple myeloma include:

Radiation

External beam radiation, which uses a machine to beam energy at the cancer, can be used to treat:

  • Painful bone lesions that haven’t responded to chemotherapy.
  • Spinal compression due to tumor

Surgery

Surgeons can insert rods and plates to support fragile bones.

There are two treatments for fractured vertebrae that can stabilize the bone and help ease back pain:

  • Percutaneous vertebroplasty: Your doctor injects the broken vertebrae with medical-grade cement.
  • Balloon kyphoplasty: The doctor uses a tool called an inflatable bone tamp to create a space in the vertebra to inject medical-grade cement and shore up the bone.

Intrathecal Pump

Your doctor might talk to you about this device, which is inserted into your body and drips pain medicine into the area around your spinal cord.

TENS

Short for transcutaneous electrical nerve stimulator, this device goes on your skin and releases low-voltage electricity to block nerve pain signals.

Other Pain Relief Options

Along with medication, natural remedies along with alternative and complementary treatments may ease pain, lower stress, and help you feel better. These include:

  • Physical therapy
  • Heat or cold applied to painful areas of the body
  • Exercise
  • Acupuncture
  • Massage
  • Counseling to ease stress
  • Meditation
  • Hypnosis
  • Guided imagery
  • Reiki
  • Therapeutic touch
  • Music therapy

Talk to your doctor before you try any complementary therapy to make sure it's a good choice for you.

A healthy lifestyle also can help you feel better with multiple myeloma and may help you fight pain. Healthy eating and regular exercise can give you energy, keep your muscles and bones strong, and curb your stress. Talk to your doctor or nurse about how much rest you need each day and how often you can be active.

Smoking and drinking too much may make you feel worse. Ask your doctor for help quitting or cutting back.

WebMD Medical Reference Reviewed by Neha Pathak, MD on May 08, 2019

Sources

SOURCES:

Leukemia and Lymphoma Society: “Pain Management Facts.”

International Myeloma Foundation: “Pain Management in Multiple Myeloma.”

Memorial Sloan Kettering Cancer Center: “Pain Management,” “Herbs, Botanicals, and Others.”

Radiological Society of North America: “Nerve Blocks.”

Mount Sinai Hospital: “Intrathecal Pain Pump Insertion.”

American Association of Neurological Surgeons: “Spinal Cord Stimulation.”

American Cancer Society: “Lifestyle Changes After Having Multiple Myeloma.”

UpToDate: “Cancer pain management: Adjuvant analgesics (coanalgesics).”

Johns Hopkins Medicine: “Sympathetic Nerve Blocks for Pain.”

Myeloma UK: “Pain and myeloma.”

American Cancer Society: “Signs and Symptoms of Multiple Myeloma.”

UpToDate: “Patient education: Multiple myeloma symptoms, diagnosis, and staging (Beyond the Basics),” “Patient education: Multiple myeloma treatment (Beyond the Basics).”

Ontario Health Technology Assessment Series: “Balloon Kyphoplasty.”

American Family Physician: “Percutaneous Vertebroplasty: New Treatment for Vertebral Compression Fractures.”

Mayo Clinic: “Multiple Myeloma.”

NIH Medline Plus: “Opioids and Chronic Pain.”

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