Analgesia

Pain arising from myeloma bone disease may be localised or general and it may be acute e.g. from a fracture or tumour expansion, or chronic such as from a permanent skeletal change. Systemic analgesia, localised treatments and non-pharmacological interventions may be used in combination to relieve pain, increase mobility and improve quality of life. Chronic pain in particular will require a multidisciplinary approach including physiotherapy, occupational therapy, pain specialists and psychology.

Effective pain management is important because of the psychosocial aspects of pain and the strong evidence of its relationship with depression and anxiety. The main types of analgesia use to treat bone pain are either non-opioid analgesics such as paracetamol or opioid analgesics such as codeine, morphine and morphine-like synthetic compounds. Corticosteroids such as dexamethasone may relieve bone pain in advanced disease.

For neuropathic pain caused by spinal cord compression, other types of drugs such as gabapentin, pregabalin, amitriptyline and duloxetine are used.