Multiple myeloma can weaken your bones. This raises your risk of fractures (breaks) and bone pain.
Why does multiple myeloma cause bone pain?
Myeloma cells can form tumors in bone marrow that can spread from the marrow and harm bone tissue. This can cause bone-related problems in your:
- Back and spine
Some people feel multiple myeloma bone pain at night, when they shift position in bed.
Myeloma cells can cause bone marrow cells to remove calcium from your bones. This causes soft spots called osteolytic (OS-tee-oh-LIH-tik) lesions.
How MSK treats multiple myeloma bone pain
If you have bone fractures from multiple myeloma, we use metal rods and plates. They help your bones support weight. Your care team also may suggest you wear a back brace or a neck brace. Braces can support your bones and help with pain.
We also may recommend you schedule a consultation visit with our rehabilitation medicine doctors. They can talk with you about a supportive care program of exercise and physical therapy.
Bone-modifying agents (BMAs) are drugs that strengthen bones and prevent fractures. There are 2 kinds of BMAs.
Bisphosphonates: The most common bisphosphonate is a drug called zoledronic acid (Zometa®). It’s given as an infusion into your vein.
RANKL inhibitors: A drug called denosumab (Xgeva®) helps stop bone resorption, a process that harms bones. It’s given as an injection.
Before you start treatment, it’s important to tell your care team if you have any problems with your teeth or mouth. BMAs can cause a rare side effect that harms your jaw, called osteonecrosis of the jaw (ONJ).
Radiation therapy treats bone tumors from myeloma cells. This treatment will make them shrink and reduce your pain.
Radiation therapy uses high-energy beams to kill myeloma cells in bone tumors and soft-tissue plasmacytoma (PLAZ-muh-sy-TOH-muh). Plasmacytoma is a cancer that affects plasma cells and can turn into multiple myeloma.
MSK uses image-guided radiation therapy to deliver high doses of radiation to the tumor while keeping healthy tissue safe. This method uses advanced software and imaging (3D CT scans) to mold radiation doses to the shape of the tumor.
When myeloma cells die, new bone starts to replace the tissue that had cancer. Your bones hurt less and become stronger and less likely to break.
Multiple myeloma back and spine pain
Back pain often is the first symptom of multiple myeloma. However, back problems are common and may not be caused by multiple myeloma.
These are commons causes of back pain from multiple myeloma:
- A backache that lasts for months can mean multiple myeloma is harming the bones in your spine or ribs.
- Sudden, severe back pain can mean a fracture (break) or a collapsed vertebra. Your vertebrae are the bones that make up your spine.
- Pain that quickly gets worse, or pain with muscle weakness, can mean spinal cord compression. This is when a fracture causes pressure on your spinal cord.
- Shooting pain in your arms or legs can mean a tumor in your spinal column is pressing on nerves.
Talk with your doctor right away if you have these symptoms.
MSK has a team of experts in treating damage to the vertebrae (bones) of the spine. MSK’s spine tumor team includes international leaders in neurosurgery, orthopedic surgery, radiation oncology, and neuroradiology.
Our interventional radiology team will help make your spine stable. They can repair fractures in your vertebrae before your radiation therapy or surgery. The procedures are minimally invasive, which means they use methods that do less harm to your body.
These treatments can help with the pain from tumors that do not respond to radiation:
Vertebroplasty: Your doctor injects (puts) a special kind of bone cement right into a collapsed vertebra (bone in your back). This helps make it stronger.
Kyphoplasty: This procedure helps make a weak or fractured vertebra more stable. Guided by an X-ray, your doctor will place 2 needles through your skin and back muscles into your vertebra. They will then inflate a small balloon to make a space inside your bone. They inject bone cement into the bone to make it stronger.
These procedures can help improve your mobility and quality of life. They usually are outpatient procedures, which means you do not have to stay in the hospital.
A kyphoplasty does not work well for some people. Our interventional radiology team is exploring whether it helps to put a rod through the skin for spine support. This can help you avoid surgery.
Pain management for multiple myeloma
Most people with multiple myeloma have some pain from the disease. Your pain can be from a bone fracture (break) or a from tumor pressing against a nerve.
Your MSK care team has experts in managing pain. They will choose pain medications and pain management methods that are right for your type of pain.
Our supportive care pain management program monitors people with myeloma who are being cared for at home. We work together with your infusion company, visiting nurses, and hospice workers.
Before you start a pain management program, your doctor will look for the cause and location of your pain. For example, back pain can be caused by many things. Your doctor will find out if the cause is multiple myeloma, or a tumor pinching nerves or compressing your spinal cord.
We use X-rays, CT scans, or MRI scans to locate tumors before choosing a pain control plan.
Avoid over-the-counter drugs
Avoid taking over-the-counter medications for managing pain, unless your doctor tells you to take them. These drugs include nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. They can affect cancer treatments or interact with other medications in harmful ways.
If you have any questions about the use of NSAIDs, talk with your doctor.
There are many good options to control pain from multiple myeloma. It’s important to take your pain medication safely.
Analgesics are the most common pain relievers for bone pain. The strongest analgesics are opioids, also called narcotics. They’re prescribed to help with moderate to severe pain.
The most common opioids are codeine, morphine, and morphine-like drugs. There are a few ways to take analgesics:
- A skin patch changed every 2 to 3 days.
- A time-release form that can be taken less often.
- A small portable pump that keeps giving you pain medication through your veins.
Drugs for nerve damage
To help with pain from nerve damage, your doctor may prescribe anticonvulsant (antiseizure) and antidepressant drugs. Some of these medications can slow or stop the pain signals sent by nerve cells to the brain.
Your care team may use radiation therapy and surgery to control pain from multiple myeloma.
Radiation therapy can shrink tumors that are growing near nerves and pressing on them.
Surgery can treat fractures caused by weakened bones. Surgeons put in plates and rods to support weak bones. They also may suggest you wear a back or neck brace to support bones and relieve pain.
Integrative medicine therapies, also called complementary therapies, are therapies and treatments that go along with your cancer care. They can help control symptoms, including pain.
MSK researchers are studying how well these complementary pain control methods help people with multiple myeloma.
Contact our Integrative Medicine Service for more information about complementary therapies.