Mechanisms and treatment of bone pain in multiple myeloma

Abstract

Purpose of reviewMultiple myeloma is a haematological malignancy of differentiated B lymphocytes, known as plasma cells. The disease is common in the UK (incidence of 9 cases per 100 000 people) and the most frequent presentation is bone pain caused by skeletal damage. Patients with myeloma also experience neuropathic pain induced by chemotherapy. The management of pain in multiple myeloma is frequently demanding and often sub-optimally addressed. This review seeks to summarize a rational approach to the management of pain experienced by multiple myeloma patients. Recent findingsBone pain has a dramatic detrimental impact on a patient's physical capacity, and therefore, quality of life. Various mechanisms of bone pain have been elucidated; however, neuropathic bone pain in multiple myeloma is not completely understood. Potential mechanisms for this phenomenon; namely increased intraosseous pressure and the acidity of the bone marrow in the disease state will be interrogated. The current analgesic pathways used to treat multiple myeloma bone pain and new advances in therapies that may confer future benefit to patients will briefly be reviewed.

Patients with multiple myeloma referred for palliative care consultation: from retrospective analysis to future directions to improve clinical outcomes

“…A large percentage of our study population required opioids, with or without paracetamol, and adjuvant therapy, for pain control. Given that patients with MM often have severe pain or a difficult type of pain to treat, their management is best suited to a specialized PC team [3,4,8,18]. Furthermore, the rapid development of MM treatment strategies has highlighted the need to carry out more in-depth research into biological issues such as the interactions between opioids and proteasome inhibitors or immunomodulating agents [3].…”

“…The causes of this symptom differ, and the different types of pain generally occur at different stages of the disease. Pain has a dramatic impact on patients, compromising mobility, independence, and quality of life [ 3 , 8 ]. In agreement with literature data, the majority of the MM patients referred to our PC unit experienced pain, the main causes being MM-related bone disease and chemotherapy-induced peripheral neuropathy.…”

“…Analgesic therapy consists of opioids associated with bisphosphonates, while radiotherapy or orthopedic surgery may be necessary in selected cases. Adjuvant drugs are also often needed [ 3 , 6 – 8 ].…”

O Uso Da Cannabis Medicinal No Manejo Da Dor Em Cuidados Paliativos: Conflitos E Perspectivas Futuras

“…Alguns estudos que abordaram pacientes oncológicos, demonstraram resultados animadores na redução de dor, alívio de náuseas e vômitos e melhora na qualidade de vida. No entanto, efeitos colaterais como tontura, xerostomia, aumento de apetite, sonolência e efeito psicoativo foram observados 7,8,9 . Outros artigos têm mostrado benefícios no uso da Cannabis em cuidados paliativos de pacientes com mieloma múltiplo, com melhora da dor e melhora da dor na esclerose múltipla 17,18 .…”

Sensory nerves: A driver of the vicious cycle in bone metastasis?

“…Osteoclasts play a central role in the pathophysiology of bone metastasis via establishing so-called “the vicious cycle” with cancer cells [43] , [44] , [45] , [46] . Reduction of CABP in patients with bone metastasis of solid cancers [4] , [5] , [56] and MM bone disease [89] by the treatment with the specific inhibitors of osteoclasts, such as bisphosphonates and denosumab, indicates that osteoclasts are responsible for inducing CABP. Consistent with these clinical results, several preclinical studies including ours also reported that inhibition of osteoclastic bone resorption by OPG [90] and zoledronic acid [36] , [91] reduced CABP as well.…”