Tips for Managing Multiple Myeloma Pain
Judi Ebbert, PhD, MPH, RN | Oct 27, 2017
Multiple myeloma is a type of cancer that targets the plasma cells in bone marrow. Healthy plasma cells attack and kill germs. A change in the bone marrow or a mutation in a plasma cell’s DNA can cause the cell to become malignant and reproduce rapidly. The malignant cells form a plasmacytoma. A person who has more than one plasmacytoma has multiple myeloma. Multiple myeloma tumors form in bone but can spread to other organs.
Understanding multiple myeloma’s impact on the body
Multiple myeloma reduces the number of healthy red and white blood cells and platelets in bone marrow. The immune system’s ability to fight infection can be compromised. Bone lesions form and can lead to bone breaks. Bones in the spine can collapse and pinch nerves. Bone breakdown can release too much calcium into the bloodstream, causing extreme thirst and frequent urination, kidney problems, stomach pain, and constipation.
Understanding the possible sources of multiple myeloma pain
Bone breaks, pinched nerves, infections, and excess calcium in the blood are sources of pain. Bone pain can be particularly severe. Pain from a pinched nerve is also severe and can radiate to various parts of the upper and lower back and elsewhere in the body. Infection pain may be related to the type of infection and where it is located.
Provide a precise pain report to the doctor
Pain relief is a priority, and detailed communication related to the pain experience is critical in finding an effective plan that brings relief. It’s important to log when the pain first started, where it is, whether it’s constant or goes away and returns, how frequently it occurs, the severity from 1 to 10 (least to most painful), and whether the severity varies. With this much detail, along with an examination and tests to confirm the source, relief is that much more attainable.
Know the options for managing pain
An array of pain interventions, used alone or in combination, can bring relief. Analgesics relieve pain and are commonly given to control pain from multiple myeloma. Opioids are the strongest prescribed analgesics, and can be taken in pill or lozenge form, or dispensed by a patch worn on the skin. Sometimes a portable pump is used to provide continuous release of an analgesic intravenously.
Bone pain interventions
Treating multiple myeloma with radiation therapy and/or chemotherapy to reduce cancerous plasma cells helps to relieve pain caused by multiple myeloma. If a bone has broken, an orthopedic cancer surgeon may need to operate to repair the break. The surgeon would repair the break and might insert a rod or plate for extra support. Along with the surgery, analgesics would be given, and radiation therapy might be used to shrink the tumor in the bone.
Nerve pain interventions
Certain drugs are especially well suited for relieving the pain caused by nerve damage. Among them are antidepressants and anti-seizure medications. How do they work to stop nerve pain? By blocking pain signals between the nerve cells and the brain. Analgesics also might be given, as well as chemotherapy and/or radiation to reduce the size of the tumor and the number of malignant plasma cells in the bone marrow.
Interventions for hypercalcemia
Hypercalcemia can be diagnosed by determining the level of calcium in the blood. Symptoms can include abdominal pain, lethargy, confusion, constipation, insomnia, dry and itchy skin, thirst, frequent urination, bloody or foamy urine, puffy eyes, swollen ankles, and muscle cramps. The best intervention is removal of the myeloma tumor. In addition, oral or intravenous bisphosphonates can be given. Resolving hypercalcemia is important because it can cause kidney damage and even death.
Interventions for kidney damage
While pain may not be the primary symptom of kidney damage from hypercalcemia, it’s important to know the symptoms listed in the previous slide. Remember that hypercalcemia can cause kidney damage, which can be deadly. Interventions to reverse kidney damage may include glucocorticoids, which are an anti-inflammatory medication. Dialysis can reduce strain on the kidneys, and chemotherapy can be modified to reduce damage to the kidneys.
What about infections?
Infections are a significant risk because multiple myeloma compromises the immune system. People with the disease are at increased risk for pneumonia, skin infections, and shingles, and infections of the sinuses and urinary tract. The multiple myeloma medication bortezomib can increase risk for reactivating cold sores. Thalidomide and lenalidomide can increase risk for febrile neutropenia, herpes, and oral candidiasis and pneumonia. At the first sign of an infection, seek help from a doctor.
Complementary therapies contribute to pain relief
Massage can relax muscles and relieve pressure with gentle stretching. Acupuncture relieves pain for many. Meditation and visualization also can reduce the level of pain. Acupuncture and analgesics with chemotherapy or radiation may relieve pain and other symptoms better than one or two therapies alone. The last word in smart pain management is detail. Precise reporting of location, date of onset, severity, frequency, and duration will increase the likelihood for effective pain relief.