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Pain Management for Multiple Myeloma

A majority of people with multiple myeloma experience some pain related to the disease. The pain may be the result of a bone fracture or due to 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 before.

Specialized Pain Management Service

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

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

MSK doctors use x-rays, CT scans, and MRI scans to pinpoint the location of tumors and to create a pain control plan that is tailored specifically to you.

Pain Medications

Approaches to pain control for people with multiple myeloma have improved in recent years. There are many more options to effectively target pain.

Analgesics

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

There are varying ways to take analgesics. For example, some people 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 every two to three days. Other opioids come in a sustained-release form, so they don’t need to be taken frequently. People with severe chronic pain can also carry a small portable pump that continuously dispenses pain medication intravenously.

Fentanyl is also available as a lozenge on a stick (like a lollipop) and as a tablet that dissolves in the mouth. By sucking on the lozenge or as the tablet dissolves, the medication is absorbed through the mucosal membrane that lines the mouth. It can provide rapid pain relief. This form of medication is especially useful for pain due to movement or a sudden, temporary flare of pain.

Drugs for Nerve Damage

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

Avoiding Over-the-Counter Drugs

Over-the-counter medications for managing pain should be avoided unless your doctor specifically tells you that you may take them. This includes nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs, like aspirin and ibuprofen, 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

MSK doctors 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 due to weakened bones are usually treated with surgery. Surgeons can insert plates and rods to support fragile bones. We may suggest that people also wear a back brace or a neck brace to support bones and relieve pain.

Pain Management Using Integrative Medicine

Relaxation and visualization techniques reduce the intensity of pain for some people when used in combination with pain medication. Massage and acupuncture may also provide some relief. Researchers at MSK are studying how well these complementary pain control techniques help people with multiple myeloma and other cancers.

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