Bone damage and pain

Bone pain is the most common symptom of myeloma. Myeloma cells speed up the destruction of bone cells and slow down the production of new cells to replace them. This causes areas of bone to get weaker and sometimes break (fracture).

Doctors and nurses who specialise in controlling pain (palliative care specialists) will work with your cancer team and your GP to make sure your pain is controlled.

Your doctor or nurse will start with an assessment of your pain. They will then talk to you about treatments such as:

  • Painkilling drugs – There are many different painkilling drugs available.
  • Bisphosphonates – These drugs can strengthen weakened bones and reduce pain. Some bisphosphonates may also help treat myeloma.
  • Radiotherapy – This uses high-energy rays to destroy myeloma cells while doing as little harm as possible to normal cells. It can often relieve pain in bones and also allow the bones to repair themselves.
  • Surgery – Surgery is sometimes needed to repair bones that have been damaged or weakened by myeloma.

Treating bone damage and pain

The most common symptom of myeloma is bone pain. About 7 in 10 people (70%) have lower back or rib pain. Other bones may be affected too, such as the skull or pelvis.

Myeloma cells speed up the destruction of bone cells and slow down the production of new cells to replace them. This causes areas of bone to get weaker and sometimes fracture (break). It’s important to tell your doctors and nurses about any pain this causes so they can treat it.

Doctors and nurses who specialise in controlling pain and other cancer symptoms are sometimes called palliative care specialists. They are based in hospitals, hospices, palliative care units and pain clinics. They will work with your cancer team and your GP to make sure your pain is controlled. It is important to remember that cancer pain can almost always be reduced.

Your doctor or nurse will start with an assessment of your pain. You will have assessments throughout your treatment to make sure your pain is being controlled.

They will then talk to you about treatments such as:

  • painkilling drugs to treat different types of pain
  • bisphosphonates
  • radiotherapy
  • surgery.

Your palliative care team may also talk to you about other therapies.


Pain assessment

Your doctor or nurse will try to find the best treatment to manage your pain. Give them as much information as you can to help them to assess your pain and plan treatment.

You may want to think about the following questions.

Where is the pain?

Is the pain in one part of your body, or in more than one place?

What is the pain like?

You might use different words to describe your pain, such as: aching, tender, sharp, hot, burning, nagging, intense, stabbing, tingling, dull, throbbing.

How bad is the pain?

If you measured your pain on a scale of 0–10, what number would you rate it? (0 means no pain and 10 means the worst pain you have ever had.)

When are you in pain?

Are you in pain all the time? Or does it come and go? Does it get better or worse when you sit still? What happens when you move? Is it better or worse at night?

Does anything make the pain better or worse?

Do you feel better or worse when you’re standing, sitting or lying down? Does a heat pad or ice pack help? Do the painkillers stop the pain or just reduce it, and for how long?

How does the pain affect your daily life?

Does it stop you moving around? Does it stop you sitting for very long? Does the pain stop you concentrating or affect your sleep?

Keeping a pain diary

It can help to keep a record of your pain. Write down how bad it is at different times of day and note anything that makes it better or worse. This information can help you talk about your pain with your doctor or nurses. Our booklet Understanding myeloma includes a pain diary to help. You can photocopy it to use again.


Painkilling drugs

There are many painkilling drugs available to treat different types and levels of pain. They come in different forms, including tablets, liquid medicines and skin patches. Painkillers can also be given by injection or infusion into a vein.

A group of drugs called non-steroidal anti-inflammatory drugs (such as ibuprofen) can cause kidney damage in people with myeloma. You should check with your doctor or nurse before taking these.


Bisphosphonates

Bisphosphonates are drugs that can strengthen weakened bones and reduce pain. They can also reduce the amount of excess calcium in the blood (hypercalcaemia). As bisphosphonates can help delay bone damage, you may start treatment before you have any bone problems.

Research has shown that some bisphosphonates may also help treat myeloma. As part of your treatment, you may be invited to enter a clinical trial.

The bisphosphonates that are most often used in myeloma are:

Bisphosphonates may be given as a drip into a vein (intravenous infusion) once a month. They are also available as tablets. It’s very important to take the tablets exactly as you have been told.

Generally, side effects are mild. They include indigestion and feeling sick. A very rare side effect of bisphosphonates is osteonecrosis of the jaw. This leads to damage and decay of the jaw bone. You will be advised to see a dentist before starting treatment. Let your dentist know you will be taking bisphosphonates. If you need any dental treatment while having this treatment, tell your doctor.


Radiotherapy

Radiotherapy treats myeloma by using high-energy rays to destroy the myeloma cells while doing as little harm as possible to normal cells. The rays can be directed at the bones where the myeloma cells have created a weak area. This treatment can often relieve pain in bones and also allow the bones to repair themselves. You may only need one or two treatments.

Radiotherapy may also be given if you develop spinal cord compression. In advanced myeloma, if chemotherapy is no longer working, radiotherapy can be given to reduce symptoms and control the disease for some time.

You have radiotherapy in the hospital radiotherapy department. If you’re having a course of treatment, you will go to the department before your treatment starts. The radiotherapy staff will make a radiotherapy plan for you. This helps them work out the exact dose of radiotherapy and the area to be treated. Normally, treatment is given daily Monday–Friday for 2–4 weeks, with a rest at the weekends. If you only need one or two treatments, you may not need such a detailed planning appointment.

Radiotherapy for myeloma can cause side effects. These can easily be treated – just let your doctor or nurse know. Any side effects should improve once your course of treatment is over, but tell your doctor if they continue.

Radiotherapy can make you feel very tired. Try to get as much rest as you can, especially if you have to travel each day for your treatment.


Surgery

Surgery is sometimes needed to repair bones that have been damaged or weakened by myeloma. The surgeon can strengthen the damaged bone with a metal pin or plate. Once these are in place, they can’t be felt or seen. You may also need radiotherapy to the area to destroy the myeloma cells and help the bone heal.

If the bones in the spine (vertebrae) are weakened by the myeloma, they may collapse. This is known as a compression fracture and it can cause pain, difficulty moving around and loss of height. It is often treated with painkillers and bed rest and by wearing a spinal brace. Operations that can be used to treat compression fractures of the spine include the following:

  • Vertebroplasty– The surgeon or radiologist injects a special cement into the vertebrae. This can strengthen the bone and relieve pain caused by a compression fracture.
  • Balloon kyphoplasty– The surgeon or radiologist inserts one or two balloons, called inflatable bone tamps, between the vertebrae and then slowly inflates them. Once the bones return to their normal position, bone cement is injected (as in a vertebroplasty). This improves the strength of the spine, which can relieve pain and help you move around more easily.

These operations will only be carried out in specialist centres. Side effects are not common, but they can include infection or damage to the nerves in the spine.

If these treatments may be suitable for you, your doctor or specialist nurse will explain more about them. They will usually try other ways of controlling your pain first.


Other treatments

Your pain team may talk to you about other possible ways of helping with your pain. These may include:

  • physiotherapy
  • nerve blocks
  • TENS machines
  • relaxation techniques.

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