Managing Bone Disease With Multiple Myeloma

Pain control

The majority of myeloma patients (70–80%) suffer from pain, and this could be the major complaint at the time of diagnosis. Experts recommend using a pain assessment scale from 0-10. A score of 5 or above would be moderate to severe pain and patients should be referred to a pain management team. For mild pain, Tylenol or similar paracetamol can be used. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) like aspirin, Motrin, Advil or Aleve should be avoided because they could affect the kidneys. Patients with moderate to severe pain may need opioids like tramadol, oxycodone, fentanyl patches, and morphine. However, side effects from these opioids (like sedation, neurological effects and constipation) should be watched in all patients, especially the elderly. 

Radiotherapy

Historically, radiotherapy has been an important part of myeloma treatment. Radiotherapy can be used if a patient has a single bone plasmacytoma and could be curative in some cases. It can also be used as a pain control measure, reduce spinal cord compression, pathological fractures, soft tissue plasmacytomas, and control local neurological symptoms. The major risk of radiotherapy is permanent bone marrow damage, which can affect the ability to harvest stem cells for future transplants. The most common use of radiotherapy is for pain control, which historically has provided a 90% success rate.

Vertebroplasty/kyphoplasty

This is a minimal invasive procedure, carried out under local or general anesthesia. Vertebroplasty includes the injection of bone cement into a vertebrae to stabilize the bone or to provide pain relief. Kyphoplasty is the same type of procedure where inflatable balloon is placed into the vertebral body to expand it and then followed by injection of bone cement. Potential complication of this procedure is cement leakage which could cause nerve irritation or cord compression and embolization of cement.