Multiple myeloma and back pain

Multiple myeloma is a rare cause of back pain. Which is often incorrectly diagnosed in the initial stage. It is a unique condition that can cause pain through several mechanisms in aggregate or separately. These mechanisms include irritation of the nociceptors by squeezing the tumor with the tumor, the products formed by the tumor, and the host's response to the tumor or its products.

Although the exact etiology of multiple myeloma is unknown, the following facts are known. There is a genetic predisposition to the development of myeloma. It is also known that radiation increases the frequency of the disease, which is observed in survivors of the atomic bombing during World War II. RNA viruses are also implicated in the development of multiple myeloma. The disease is rare in people younger than 40 years, the average age of diagnosis is 60 years. There is a predisposition to the male sex. Negroid race disease frequency is 2 times higher. In the world, the incidence of multiple myeloma is 3 per 100,000 population.

The most frequent manifestation of the disease is pain in the back and ribs. It occurs in more than 70% of patients who ultimately diagnose this disease. Damage to the bone is osteolytic in nature and is better manifested in contrastless radiography than in radionuclide bone studies. There is pain during movement, hypercalcemia is observed quite often, is an indicative symptom in many patients with multiple myeloma. Life-threatening infections, anemia, bleeding and kidney failure are often present in combination with symptoms of pain. Increased blood viscosity, as a result of the action of tumor products, can lead to cerebrovascular complications.

[1], [2], [3], [4], [5], [6], [7], [8]

Symptoms of multiple myeloma

Common pain is a common clinical complaint, which ultimately leads the doctor to the diagnosis of multiple myeloma. Seemingly small injury can cause abnormal compression of the vertebrae or fracture of the ribs. During physical examination, pain is often detected when moving in the affected bones, as well as tumor masses during palpation of the skull or other affected bones. Neurological signs of nerve compression due to a tumor or fracture and cerebrovascular complications are often present. Also, there may be positive signs of Trusso and Khvostek due to hypercalcemia. Anasarka due to renal failure is an unfavorable prognostic sign.

Examination

The presence of Ben Jones protein in the urine, anemia and an increase in the M protein of the tphi serum protein electrophoresis indicates a multiple myeloma. Classic "pierced" pockets in the bones of the skull and spine on radiocontrastless radiography are pathognomonic for this disease. Due to low osteoclast activity in patients with multiple myeloma, a gradionuclide study of bone with diffuse destruction can produce a negative result. MRI is indicated for all patients presumed to have multiple myeloma with signs of spinal cord compression. All patients with multiple myeloma showed serum creatinine determination, automated blood biochemistry, which includes determination (serum calcium.

Differential diagnosis of multiple myeloma

Many other bone marrow pathologies, including heavy chain disease and Waldenstrom macroglobulinemia, can mimic the clinical picture of multiple myeloma. Amyloidosis also has many clinically similar symptoms. Metastatic disease due to a tumor of the prostate or breast cancer may provoke pathological fractures of the spine and ribs and metastasis in the cranial vault that can be taken for myeloma. The results of analyzes of patients with benign monoclonal gammapathy, most of which do not need special treatment, can simulate laboratory data observed with multiple myeloma.

[9], [10], [11], [12], [13], [14]

Treatment of multiple myeloma

The management of myeloma is aimed at treating progressive bone injury and reducing myeloma proteins in the serum. Both these goals are achieved by the use of radiation therapy and chemotherapy, alone or in combination. Pulse therapy with high doses of steroids has shown effectiveness in providing symptomatic improvement and an increase in life expectancy.

Treatment of pain with multiple myeloma should start with NSAIDs or COX-2 inhibitors. To control severe pain in pathological fractures, it may be necessary to add opioid analgesics. Orthopedic adaptations, such as Kesha's bandage and rib belts, can help stabilize the spine, one should think about them in pathological fractures. Local thermal and cold applications can also be effective. Avoid repetitive movements that cause the appearance of pain. Patients who do not respond to this treatment may be given injections of local anesthetics or steroids intercostally or epidurally. In some cases, spinal injection of opioids can also be effective. Finally, radiation therapy is often required in the presence of significant damage to the bones to provide adequate pain control.

Side effects and complications

About 15% of patients with myeloma, despite aggressive therapy, die within the first three months after diagnosis. And another 15% - in each subsequent year. Common causes of death are renal failure, sepsis, hypercalcemia, bleeding, the development of acute leukemia and stroke. Non-lethal complications, such as pathological fractures, significantly complicate the life of patients with myeloma. Untimely recognition and treatment of such complications complicates patient suffering and leads to early death.

Careful examination of patients with a triad: proteinuria, pain in the spine or ribs, and changes in serum electrophoresis

Proteins, is necessary to prevent the inevitable complications of a delayed diagnosis of myeloma. Both the doctor and the patient should understand that, despite the early onset of treatment, most patients with myeloma will die within 2 to 5 years from the date of diagnosis. Epidural and intradermal injections with local anesthetics and steroids can provide good temporary relief of pain associated with myeloma.