How Can Patients With Multiple Myeloma Manage Bone Pain?

Individuals with multiple myeloma often experience bone pain, weakness, and numbness or tingling. Follow along as Patient Power co-founder Andrew Schorr has an in-depth conversation with Betsy O’Donnell, MD, of the Multiple Myeloma Disease Center at Massachusetts General Hospital, about bone health. This includes strategies for managing bone pain, what scans to expect during diagnosis, the effectiveness of certain treatments, and how diet and vitamins can affect bone-directed therapy.

Transcript | Strategies for Managing Bone Pain in Multiple Myeloma Patients

Andrew Schorr: Hello, and welcome to Patient Power. I’m Andrew Schorr, in San Diego, and joining us from Boston, Massachusetts is a myeloma specialist, Dr. Betsy O’Donnell. She’s at Massachusetts General, where she is the Director of Lifestyle Medicine, and as I said, is a myeloma specialist. Welcome to Patient Power.

Dr. O’Donnell: Thank you so much. It’s wonderful to be here.

Andrew Schorr: Dr. O’Donnell, I want to talk about myeloma and bones. I’ve interviewed people who found out they had myeloma when their grandchild hugged them, and they cracked a couple of ribs. What’s the connection between myeloma and your bones?

What Is the Connection Between Multiple Myeloma and Bone Health?

Dr. O’Donnell: That’s a great question. So, what does multiple myeloma even mean? It means multiple tumors of the bone marrow. This is a disease that is, the cancer cells grow inside your bone marrow. But in addition to that, it can make tumors in the bone from plasma cells. People with multiple myeloma may have thinner bones but may also have tumors that are at risk of fracture, just like you’ve described. Weaknesses within the ribs that can then break, when hugged tightly, or even making sudden movements, or sneezing.

Andrew Schorr: Wow. Okay, so when you have a new myeloma patient, or even along their journey with myeloma, what scans do you do to see what is the involvement of the bones?

Dr. O’Donnell: That’s a really great question. We know that up to 80% of patients who have multiple myeloma, at some point, will have involvement of their bones. There are a bunch of different ways that we can image bones. The most basic way is through what’s called a skeletal survey, which are just plain X-rays of many bones in your body. But we really replace that with some more sensitive scans. What I mean by more sensitive is, it enables us to pick up smaller bone lesions. Something like a low-dose CT scan is one modality we use, which can look at all of the bones in your body. Other imaging can be whole body MRI or a PET scan that uses a radioactive glucose molecule, along with imaging, to see where there are areas of multiple myeloma or other cancers in your body.

Andrew Schorr: Okay. Now that could be done at different points in someone’s myeloma journey. Maybe they didn’t have these scans early on, but later, you might say, I think we need to do it, right?

Dr. O’Donnell: That’s right. It’s very useful when someone is first diagnosed with multiple myeloma to have complete bone imaging, because that then serves as a baseline. So that if there is a new pain, we have a frame of reference to compare it and see if something new is going on, particularly if someone has been on a therapy for a long time.