Multiple Myeloma: Pain Management

Pictured: Paul Glare Paul Glare (center), Chief of the Palliative Medicine Service, coordinates a team of nurses and doctors focused on controlling pain in patients with multiple myeloma.

A majority of patients with multiple myeloma report that they experience some pain related to the disease. The pain may be a result of a bone fracture or of a tumor pressing against a nerve.

At Memorial Sloan Kettering, our doctors and nurses make pain control a priority. With recent improvements in understanding the biologic basis of pain, we are able to choose pain medications and pain management techniques in a much more targeted way than in the past.

Specialized pain management service

Our pain specialists are available 24 hours a day in the clinic or in the urgent care setting, and our pain management program ensures that patients who have pain are treated promptly and effectively. In addition, our specialists continue to monitor myeloma patients who are being cared for at home in collaboration with local infusion companies, visiting nurses, and hospice workers.

Before beginning a pain management program, your doctor will carefully evaluate you to determine the exact cause and location of your pain. For example, if you have back pain, the doctor will need to find out if pain is caused by multiple myeloma and if a bone lesion is pinching nerves or compressing your spinal cord.

Memorial Sloan Kettering physicians use x-rays, CT scans, and MRI scans to pinpoint the location of tumors or lesions and to create a pain control plan that is tailored specifically to you.

Pain Medications

Approaches to pain control for patients with multiple myeloma have improved in recent years, providing many more options to effectively target pain.

Analgesics

Analgesics, or pain relievers, remain the mainstay of bone pain treatment. The strongest analgesics, called opioids or narcotics, are often prescribed to control pain in myeloma patients. The most commonly prescribed drugs are codeine, morphine, and morphine-like synthetic compounds.

There are varying ways to take analgesics. For example, some patients can receive an opioid called fentanyl through a patch applied directly to the skin. This patch supplies a steady stream of medication and needs to be changed once every two to three days. Other opioids now come in a sustained-release form, so you don't need to take frequent doses of medication. Patients with severe chronic pain can also carry a small, portable pump that continuously dispenses pain medication intravenously.

Fentanyl is also available in the form of a lozenge on a stick (like a lollipop), and as a tablet that dissolves in the mouth. As you suck on the lozenge or as the tablet dissolves, the medication is absorbed through the mucosal membrane that lines your mouth and can provide rapid pain relief. This form of medication is especially useful if you experience pain when moving or feel a sudden, temporary flare of pain.

Drugs for Nerve Damage

To alleviate pain that arises mainly from nerve damage, our physicians sometimes prescribe anticonvulsant (antiseizure) and antidepressant drugs. Some of these medications can slow or stop pain signals sent by nerve cells to the brain.

Avoiding Over-the-Counter Drugs

Over-the-counter medications for managing pain, such as nonsteroidal antiinflammatory drugs (NSAIDs, including aspirin and ibuprofen), should be avoided unless your doctor specifically tells you that you may take them. These drugs can interfere with cancer treatments or interact with other medications in harmful ways.

If you have any questions about the use of NSAIDs, ask your doctor.

Radiation Therapy and Surgical Techniques

Memorial Sloan Kettering physicians sometimes use radiation therapy and surgery to control myeloma pain. Radiation therapy can relieve pain by shrinking tumors that are growing toward nerves and pressing on them.

Fractures that result from weakened bones are usually treated surgically. Surgeons can insert plates and rods to support fragile bones. Doctors often suggest that patients also wear a back brace or a neck brace to support bones and relieve pain.

Pain Management Using Integrative Medicine

Some patients find that complementary pain control techniques such as relaxation and visualization can reduce the intensity of pain when used in combination with pain medication. Massage and acupuncture also provide relief for some patients. Researchers at Memorial Sloan Kettering are studying the effectiveness of these techniques in patients with multiple myeloma and other cancers.

Contact our Integrative Medicine Service for more information about complementary therapies.