Why does multiple myeloma cause pain?

Multiple myeloma is a type of cancer in which abnormal cells reproduce in your bone marrow. Bone marrow is the spongy tissue in the middle of bones where new blood cells are made. As the cancer grows, it damages bones and leaves behind soft spots, called lesions.

Weakened bones can be very painful. About 85 percent of people with multiple myeloma will have some type of bone damage or loss, leading to pain.

Bones can weaken to the point of fracturing or breaking. About 40 percent of people with multiple myeloma develop fractures. The pain from a broken bone can be severe.

Here’s a look at the different areas of your body where you might feel pain from multiple myeloma, and how to treat each one.

If the vertebrae in your spine become weak enough, they can collapse. This is called a vertebral compression fracture. The fractured bones can put pressure on nerves in your spine, causing numbness, weakness, and an uncomfortable pins-and-needles sensation.

Two surgical procedures can treat compression fractures:

  • Kyphoplasty. The surgeon places a thin tube with a balloon at one end into the collapsed vertebrae. The balloon is then inflated to restore the bone to its original position. Cement secures the bone into place.
  • Vertebroplasty. The surgeon injects cement directly into the collapsed vertebrae.

Your doctor might recommend that you wear a back or neck brace to hold your spine in place. You can also take pain relievers to manage your discomfort. Options include:

  • over-the-counter (OTC) pain relievers such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
  • prescription pain relievers, including opioids for severe pain
  • topical ointments, creams, or patches to relieve pain in the areas where it hurts

Multiple myeloma can also weaken bones of the hips or ribs. Many of the same treatments used to strengthen vertebrae in the back also relieve pain in these bones, including:

  • chemotherapy and radiation treatment
  • over-the-counter and prescription pain relievers
  • bisphosphonates
  • calcium and vitamin D supplements

As bones break down, they release calcium into the blood. Excess calcium, called hypercalcemia, can lead to constipation. Chemotherapy and other treatments for multiple myeloma also cause this symptom by slowing the movement of digested food through your intestines.

The buildup of stool in your intestines can leave you with a bloated, painful belly. To treat constipation, try these tips:

  • Eat extra high-fiber foods, such as fruit, vegetables, beans, and whole-grain bread. If any of these foods are hard for you to eat right now, work with a dietitian to find more palatable foods.
  • Drink more fluids, especially water. This will help soften your stools and make them easier to pass.
  • Try to exercise every day. Activity helps increase the movement of food through your gastrointestinal (GI) tract.
  • Don’t rush, and don’t hold it in. Give yourself time to sit on the toilet each day. When you feel the urge to go, find a bathroom.

If these techniques don’t work, ask your doctor if you should take a fiber supplement or laxative to help relieve constipation.

The pain from nerve compression in your spine can radiate, or spread, into your arms and legs. Shooting pain, numbness, or weakness in these appendages can be a sign of a nerve problem in your back. Multiple myeloma and its treatments can also directly damage nerve cells.

The following treatments help with nerve irritation, called peripheral neuropathy:

  • gabapentin (Gralise, Neurontin, others)
  • tricyclic antidepressants
  • serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants
  • carbamazepine (Tegretol XR)
  • opioid pain relievers for severe pain

Chemotherapy is one of the main treatments for multiple myeloma. It can help with bone pain, too. Chemo uses strong drugs to kill cancer cells all over your body.

Radiation therapy is another treatment that uses powerful X-rays to shrink tumors in bones. After chemo or radiation destroy cancer cells, new bone begins to regenerate. Bones become stronger and less likely to break.

Bisphosphonates are drugs that strengthen bones and prevent them from fracturing. By supporting bones, these medications can also reduce pain. The bisphosphonates that doctors often prescribe for multiple myeloma are:

  • denosumab (Prolia, Xgeva)
  • pamidronate (Aredia)
  • zoledronic acid (Reclast)

You’ll get these drugs through an injection into a vein. To start, your doctor might give you a bisphosphonate once a month. As your bones strengthen, you may be able to taper down and get these shots less often.

Your doctor might also recommend that you take calcium and vitamin D supplements. These nutrients also help keep bones strong.

Multiple myeloma can be a painful condition, but there are many ways to manage the pain before it interferes with your life. Most importantly, follow the treatment plan your doctor recommends to control your cancer.

Take pain relievers and other medications to manage pain. You can also try non-drug interventions, such as:

  • massage
  • heat or cold applied to painful areas
  • physical therapy
  • exercise

If your pain isn’t being well-managed, talk to your doctor. There may be other techniques or treatments you haven’t tried yet.