Pain

Pain is one of the most common symptoms of myeloma. At diagnosis, over 60% of patients present with pain caused by the myeloma itself. This is primarily a consequence of bone disease but may also be a result of plasmacytoma or paraprotein deposits directly affecting nerve tissue, or major complications such as spinal cord compression.

Later in the course of myeloma, pain may arise as a side effect of treatments, for example, peripheral neuropathy and gastrointestinal toxicities caused by IMiD or proteasome inhibitors, melphalan-induced mucositis, or as a result of surgical or diagnostic procedures such as bone marrow biopsy. Co-morbid conditions for example diabetes, carpel tunnel syndrome, and infections such as pneumonia, urinary tract infections and herpes zoster, can also contribute to pain.

The consequences of untreated or uncontrolled pain can be devastating both physically and psychologically. If pain is poorly managed it can negatively impact an individual’s mobility, compromise nutritional and hydration status, impair sleep and increase the risk of anxiety, depression and social withdrawal. Prompt treatment and effective management of pain is therefore essential to maintain and improve quality of life. Particular attention needs to be brought to educating myeloma patients about peripheral neuropathy. Often thought of as an ‘expected side effect’ by patients, they must be aware that the effects are irreversible in the most part and so must be reported as they may be disabling if left unchecked. Under-reporting of pain is recognised both among healthcare professionals and patients alike. Patients can feel that pain is an unavoidable consequence of myeloma and fear their treatment will stop if they report it.

Interventions for pain are aimed at providing pain relief with minimal side effects. Several treatment options are available for myeloma patients, either to treat the cause of the pain (anti-myeloma treatment, radiotherapy) or as pain-relieving measures (analgesics, surgical interventions, complementary therapies).

It is vital that nurses communicate openly and work with their patients to identify and manage pain effectively. It is common practice to use pain assessment tools in clinical practice and nurses should use these at regular time points to document and measure patients’ pain and provide care accordingly. Individual differences in perception of pain are influenced by background, culture, genetics and gender, which should all be taken into account through thorough holistic needs assessments.