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2022-12-07T15:11:24.000Z

Understanding pain in early multiple myeloma

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Dec 7, 2022
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Learning objective: After watching this presentation, learners will be able to cite developments in the management of pain in patients with multiple myeloma.

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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 first presentation by Professor Heinz Ludwig, Wilhelminen Cancer Research Institute, Vienna, AT, on the management of pain in early multiple myeloma.

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

In this presentation, Professor Ludwig discusses the symptoms of pain at presentation and early in the course of MM (Figure 1), as well as the common sites of bone lesions (Figure 2).

Figure 1. Symptoms in patients with early multiple myeloma* 

*Data from Cleveland Clinic.1

 

Figure 2. Common sites of bone lesions in multiple myeloma*

*Adapted from Coluzzi, et al.2 Created with BioRender.com.

Watch or download the presentation to learn more about understanding pain in early multiple myeloma, including:

  • The symptoms of pain at presentation early in the disease course (01:47; slide 11)
  • The common causes of pain (03:08; slides 1213)
  • Measuring pain and its impact on quality of life using patient-reported outcomes (08:07; slides 16–25)
  • Managing myeloma pain (17:22; slides 2629)

Key points

  • Pain is the most frequent symptom of myeloma at diagnosis and even more so at relapse.​
  • Bone lesions are the major cause of pain in patients with multiple myeloma.
  • Other frequent causes are pain polyneuropathy and reactivation of herpes, as well as pain resulting from adverse events of therapy.​
  • Pain is associated with decreased health-related quality of life; therefore, pain therapy is a priority of supportive care.
  • Pain should be assessed by patients using established instruments, as caregivers tend to underestimate the severity of pain.​
  • Patient-reported outcome measures help improve symptom assessment, patient–caregiver interaction, and patient quality of life.​
  • Pain treatment depends on the cause of pain and includes a broad spectrum of interventions, such as local therapy, pain medication, and adjuvants for pain therapy.

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. Cleveland Clinic. Multiple myeloma. https://my.clevelandclinic.org/health/articles/6178-multiple-myeloma. Accessed Oct 31, 2022.​
  2. Coluzzi F, Rolke R, Mercadante S. Pain management in patients with multiple myeloma: An update. Cancers (Basel) 2019;11(12):2037. DOI: 10.3390/cancers11122037

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