Dos and don’ts in pain management in multiple myeloma

Figure 1. Evolution of pain through the course of multiple myeloma disease* 

APAP, acetaminophen (paracetamol); BP, bisphosphonate.
*Adapted from Coluzzi, et al.¹

Figure 2. Selecting opioids in patients with hepatic impairment* 

*Data from Davis² and Johnson.³

This independent educational activity was supported by Mundipharma. All content was developed independently by the faculty. The funder was allowed no influence on the content of this activity.

Disclaimer: All content produced by the Multiple Myeloma Hub is intended to adhere to the Centers for Disease Control and Prevention (CDC) Clinical Practice Guideline for Prescribing Opioids for Pain, issued in November 2022. Opioids are a class of highly addictive prescription painkillers; therefore, all information regarding their use must accurately describe the benefits and serious risks of misuse and abuse. The CDC recommendations do not apply to pain management related to sickle cell disease, cancer-related pain treatment, palliative care, or end-of-life care. Key principles to be taken into consideration include: i) nonopioid therapies are at least as effective as opioids for many common types of acute pain and are preferred for subacute and chronic pain; ii) before starting opioid therapy, clinicians should discuss with patients the realistic benefits and known risks; iii) when opioids are used, clinicians should prescribe immediate-release opioids at the lowest possible effective dosage; and iv) clinicians should regularly reevaluate with patients the benefits and risks of continued opioid therapy and when changing the dosage.