Back pain is a common and challenging symptom of myeloma and is often one of the first symptoms that people notice before being diagnosed. More than 1,200 members of MyMyelomaTeam report back pain as a top symptom.
People experience back pain from myeloma in a variety of ways. Oftentimes, they report the pain feeling like a persistent ache. MyMyelomaTeam members describe their back pain in their own words:
Sometimes, myeloma can cause vertebral compression fractures (broken bones in the spine). This can cause people to experience sudden, sharp pain in their back.
Experiencing ongoing back pain can affect your quality of life. Members of MyMyelomaTeam have reported disruptions in their daily lives due to back pain, such as not being able to enjoy hobbies. “With my current condition, I am unable to play my musical instruments,” a team member shared.
Back pain can also interfere with daily activity levels. One member wrote of their back pain, “I move slower now.” Another team member with back pain reported, “I’m not as active as I once was.”
Back pain can also make it hard to get enough sleep as well. “I have insomnia and don’t get the proper rejuvenation each night that my body craves,” a MyMyelomaTeam member wrote of their back pain. Other members report a feeling of ongoing tiredness they relate to back pain. For example: “I find myself so tired that I am napping most afternoons.”
Myeloma itself, some myeloma treatments, and conditions related to myeloma can all contribute to back pain.
Myeloma affects certain white blood cells (plasma cells) that are part of the immune system and are found in the bone marrow. Myeloma causes excessive production of abnormal plasma cells known as myeloma cells. These myeloma cells crowd the bone marrow and produce substances that interfere with the normal process of breaking down and regrowing new bone structures. The overabundance of myeloma cells puts pressure on the walls of the bone and causes pain.
The myeloma cells can move into the walls of the bone, weakening the bone faster than it can be rebuilt. These spots are called bone lesions or osteolytic lesions, and they can be painful.
When lesions occur in the spine, they can result in painful vertebral fractures. If there is more than one vertebra fracture, it can lead to spinal collapse and spinal cord compression, resulting in varying degrees of pain.
When the spine can no longer hold itself straight because of fractures, it may become curved into an abnormal posture called kyphosis, which can contribute to chronic back pain. Kyphosis can be treated with injections of a substance that rights the collapsed vertebrae. Sometimes, myeloma cells can form a tumor on the bone, which can lead to pressure and pain on the spinal nerves as well as bone pain.
Doctors have a variety of medications they use to treat myeloma, but certain drugs can intensify back pain.
Ixazomib (Ninlaro) is a protease inhibitor and a drug used to treat myeloma. Protease inhibitors halt the enzymes inside cells that are responsible for cell division. These types of drugs target tumor cells but can produce back pain as a side effect.
is a monoclonal antibody drug. Antibodies are proteins that are created by your immune system to fight infections. A monoclonal antibody is a human-made protein that can be directed to attack specific cells, such as myeloma cells. The more recent form of this drug is called daratumumab and hyaluronidase-fihj (Darzalex Faspro). Both cause kidney pain, which may manifest as lower back pain or general back pain.
There are many approaches to managing back pain in myeloma. Depending on the cause, location, and severity of your back pain, a treatment plan may involve prescribed medication, surgery, over-the-counter pain relief, and complementary therapies.
Addressing back pain starts with managing myeloma. The earlier myeloma is diagnosed and treated, the better the chance of keeping ahead of symptoms such as back pain. Beyond that, there are several options that doctors can implement to help manage the pain.
Cancer doctors (hematologists-oncologists) will narrow down the cause of the pain. Once they confirm the back pain is due to myeloma, the doctor will set up a treatment plan according to what is generating the pain — such as a fracture, a tumor pressing against the spinal cord, or an osteolytic lesion. They will also consider what type of myeloma you have, what stage it is in, and how you have responded to your treatment plan so far.
Vertebral fractures may be treated with surgical techniques, such as kyphoplasty, a minimally invasive procedure where the fractured bone is reinforced with special bone cement.
If a tumor is causing back pain, radiation therapy or surgery may bring relief by either removing or reducing the size of the tumor. Radiation therapy can also treat osteolytic lesions and may help with bone strength.
A back brace may also be prescribed to help stabilize the spine and reduce pressure in specific spots.
Finally, there are pain medications. Treating back pain with analgesics (pain relievers) is one of the foundational aspects of a pain treatment plan.
Depending on your level of pain and how frequent it is, doctors may consider prescribing opioids or narcotics. Although they can provide potent pain relief, they can also have significant side effects such as constipation and the risk of dependence.
You should not take over-the-counter pain relievers like nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen unless specifically directed by your doctor. These medications can interfere with cancer treatments as well as other drugs and can result in harmful damage to your body.
Other therapies may help manage back pain, such as physical therapy (PT). One MyMyelomaTeam member wrote: “I cannot say enough good about PT. It gave me what I needed to walk again.”
Ask your doctor about including complementary therapies, such as acupuncture or acupressure, yoga, meditation, exercise, diet, nutritional supplements, and medical massage, as potential avenues for supporting back pain relief.
Using heating pads or ice packs may offer temporary pain relief as well.
MyMyelomaTeam is the social network for people with myeloma. On MyMyelomaTeam, more than 16,000 members come together to ask questions, give advice, and share their stories with others who understand life with myeloma.
Are you living with myeloma and back pain? Share your experience in the comments below or start a conversation by posting on your Activities page.