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Pain management in multiple myeloma

ABSTRACT Introduction: Pain afflicts quality of life and is common in cancer patients. Multiple myeloma is a hematological malignancy often associated with pain. In the last two decades overall survival improved thanks to introduction of novel chemotherapeutic agents such as the proteasome inhibitor bortezomib, and the immunomodulatory drug thalidomide. Unfortunately, these agents could be responsible for development of painful peripheral neuropathy. Areas covered: This review describes strategies for prevention and treatment of pain in multiple myeloma, focusing especially on bone lesions and neuropathy, considered as the main causes of pain in the disease. Expert commentary: Management of pain in multiple myeloma requires a multidisciplinary clinical assessment and a careful follow-up to offer the best treatment, best matched to each patient. Mild to moderate pain could be treated with paracetamol and/or weak opioids, while severe pain requires stronger analgesics. Bisphosphonates, kyphoplasty, vertebroplasty, and radiotherapy are specifically indicated for bone involvement. Neuropathy could be treated removing the cause and controlling symptoms. If it is drug-related, appropriate dose modification/suspension is mandatory. Further studies are needed to better understand pain etiopathogenesis, allowing elaboration of more efficacious analgesic strategies, especially for neuropathic and chronic pain management in order to improve quality of life in cancer patients.