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Dos and don’ts in pain management in multiple myeloma

Dec 8, 2022
Learning objective: After watching this presentation, learners will be able to cite developments in the management of pain in patients with multiple myeloma.

On November 10, 2022, the Multiple Myeloma Hub held a virtual symposium on the topic of holistic pain management in multiple myeloma, with three established leaders in the field talking on different elements of pain management.

Here, we share the presentation by Flaminia Coluzzi, Sapienza University of Rome, Rome, IT, on the practical considerations in the management of pain in patients with multiple myeloma and selection of appropriate analgesia.

The Multiple Myeloma Hub has previously covered the need for the management of pain in patients with multiple myeloma.

In this presentation, Coluzzi discusses the dos and don’ts in pain management, with recommendations for best practice, including consideration of the evolution of pain through the course of the disease (Figure 1) and selecting appropriate analgesia in patients with comorbidities, such as liver impairment (Figure 2).

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

Watch or download the presentation to learn more about:

  • Using a mechanism-based approach to analgesia selection (0:55; slides 5356)
  • Maladaptive pain (3:07; slide 57)
  • Tailored therapy (6:17; slides 60–70)
  • Preventing chronification of pain (11:51; slides 71–72)
  • Using rapid-acting opioids (12:57; slides 7377)
  • Management of neuropathic pain (15:23; slides 7886)
  • Opioid-induced side effects (17:30; slides 8792)

Symposium slides

To download the slides presented, click here.

Download here

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.

  1. Coluzzi F, Rolke R, Mercadante S. Pain management in patients with multiple myeloma: An update. Cancers (Basel). 2019;11(12):2037. DOI: 3390/cancers11122037
  2. Davis M. Cholestasis and endogenous opioids: liver disease and exogenous opioid pharmacokinetics. Clin Pharmacokinet. 2007;46(10):825-850.​ DOI: 2165/00003088-200746100-00002
  3. Johnson SJ. Opioid safety in patients with renal or hepatic dysfunction. Pain Treatment Topics.  Accessed Nov 3, 2022.​


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