Ask The Nurse // 5th July 2021
Pain is the most common symptom of myeloma and often the first symptom patients notice before diagnosis. Chronic pain can be difficult to live with and for many, it can be frustrating and debilitating. Finding effective ways to relieve or control pain can make a huge difference to everyday life and can help myeloma patients stay more positive and active. This is why pain management is an important part of myeloma care.
In this month’s blog, we answer some of the questions that we are often asked about pain management in myeloma.
When should I talk to my healthcare team about the pain I am experiencing due to my myeloma?
It is important that you are always open and honest about any pain you are having due to your myeloma or myeloma treatments. This is especially true when the pain is new, getting worse or affecting your mood or daily activities.
There are several different treatments and support services that can help you manage your pain and by having open conversations with your healthcare team they can work to find the right solution for you.
Some patients find keeping a diary or taking notes about where and when the pain occurs, and what it feels like helps them discuss the pain they are having with their team.
Are there any supportive treatments that can help me manage my pain?
Several treatments can help reduce your pain.
Painkillers (analgesics): There are many different types of painkiller that are effective for different levels and types of pain.
- If pain is mild, it can often be controlled with simple painkillers such as paracetamol. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin aren’t usually given to myeloma patients as they can increase the risk of kidney damage
- Mild to moderate pain is usually controlled with weak opioids such as codeine, dihydrocodeine or tramadol
- Moderate to severe pain is usually controlled with stronger opioids such as morphine, oxycodone or fentanyl
It is important that you find the treatment that works best for you, so speak to your healthcare team if a particular painkiller is not working or is causing side effects. If you are having persistent problems with pain, you can ask to be referred to a pain specialist.
Radiotherapy: Radiotherapy can be used to relieve localised pain.
Surgery: Surgery is sometimes used to treat fractures or strengthen areas of bone that are causing pain. For example, two surgical procedures that treat vertebral fractures, known as percutaneous vertebroplasty and balloon kyphoplasty, can relieve back pain and stabilise the vertebrae (bones in the spine). Please note surgical interventions would not be recommended until the myeloma itself is under control.
Nerve blockers: If your pain is caused by peripheral neuropathy, your haematologist might prescribe a nerve blocker such as gabapentin or pregabalin to relieve your pain.
I am finding it hard to cope with my pain, what can I do?
Several support services can help you cope with pain and your day-to-day activities. If dealing with pain is difficult, talk to your healthcare team and ask if you can be referred to a specialist department, such as:
Occupational therapy: They can provide equipment to help with everyday tasks if you have lost some dexterity or physical ability and make suggestions about helpful home adaptations.
Physiotherapy: They may be able to show you different ways of sitting, sleeping, or moving to help manage the pain. They can also give you advice on safe ways to increase your activity or mobility.
Psychology: Pain can be mentally challenging. A psychologist can help either when your pain is affecting your mood and motivation or when your mood is making the pain more challenging to cope with.
Pain team: They can help you find the right type and dose of painkiller or nerve blocker to manage your pain effectively.
You may find that you are referred to the palliative care team. Although often associated with end-of-life care, palliative care teams are specialists in the management of symptoms and complications at all stages of illness. They offer a holistic approach and focus on quality of life.
Are there things I can do at home to help relieve some of the pain?
There are many non-medical strategies that you can try to help relieve your pain. Not all of these options are suitable for all patients, and you should ask your healthcare team for advice before starting a new treatment.
- Topical creams can help alleviate pain or burning sensations in the hands or feet caused by peripheral neuropathy (i.e. menthol, capsaicin or lidocaine creams)
- Hot water bottles, microwavable wheat bags, electric heat pads and ice packs can be very effective in providing short term pain relief
- Transcutaneous electrical nerve stimulation (TENS) machines deliver small electrical pulses to the body via electrodes placed on the skin. The electrical impulses can reduce the pain signals going to the spinal cord and the brain
- Meditation, visualisation, mindfulness, relaxation or a combination of these can help relieve pain