Many patients with multiple myeloma will experience varying degrees of pain during the course of their treatment. Their pain may be caused by the disease itself or from complications caused by a weakened immune system or side effects of medication. A successful pain management plan is a crucial part of treatment and must be individualized for each patient.

Our pain management specialist begins working with patients at the onset of their treatment and is available throughout their care. She works closely with the patient's clinical care team to develop and coordinate multidisciplinary pain management therapies. Together, they look at all aspects of pain to determine its' cause and location and the most effective interventions. She also closely monitors patients' responses to pain management therapies and the interactions of drug therapies to help limit side effects.

Q&A with Cathy Handy, Ph.D., RN, AOCN^®, pain management expert.

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Q: How important is pain management for the myeloma patient?

A: Managing pain is vitally important in helping myeloma patients get through their course of therapy. If a patient is really troubled by pain, he or she may think about not continuing treatment. So, it's critical for us to get the pain under control in a fashion that doesn't interfere with the patient's lifestyle.

Q: Why do Myeloma patients experience pain during treatment?

A: Patients may experience pain for different reasons. The myeloma itself can cause bone lesions and fractures that can be very painful. Or, some of the therapies can cause neuropathies, which are interferences to the nerve, especially the nerves of the peripheral nervous system. When drugs cause damage to the nerves, patients can actually lose sensation in their hands and feet. Or, they can experience painful or odd sensations in their hands and feet, like numbness and tingling. This can be quite uncomfortable. Several of the agents that are very effective at treating myeloma, unfortunately can cause these neuropathies.

Q: At what point in a patient's care are you called in to assist with pain management?

A: The myeloma care team often likes to get me involved in the beginning. They are among the most frequent users of my services, because their patients are going into the system for quite some time and the treatment is very complex. I sometimes see patients on their very first visit, especially if they come in with painful bone lesions.

Often times, the pain will resolve as patients respond to therapy or undergo surgical intervention. I always stay in touch with patients, but they may not need my services as actively. If they start to develop adverse reactions to their therapies, I'll get involved again and really work with the physicians or nurse practitioner to work out a good plan of care.

Q: Why is pain management for multiple myeloma so complex?

A: Pain management is really multidisciplinary. It requires a lot of interaction among the members of the treatment team. For example, often times with the neuropathic pain, it's not enough to give patients pain killers, you also need what we call adjunct medication. Sometimes, we'll make referrals to neurologists, rehab specialists, or podiatrists. I also refer patients to our complementary therapies nurse because neuropathy can respond to acupuncture.

We also pay close attention to the side effects that can occur from the pain medication. Certain pain medications can cause kidney problems, and patients with myeloma are very prone to kidney issues. Other medications can cause constipation or sedation, so, it's really a matter of trying to get the pain under control as quickly as possible, but not cause a number of other problems for the patient.

Q: What impact can pain have on a patient's treatment?

A: Patients say, "I'm exhausted all the time," "I'm nauseous all the time," or "I'm in pain." Those are frequently the reasons why people may consider stopping therapy. Our approach is to address the symptoms before they become problematic.

Some patients feel pain but may not tell anyone out of fear that they will be taken off their treatment regiment. They should not be afraid and always tell someone on their treatment team how they are feeling so we can help them. The treatment team is always looking out for other symptoms, such as a change in weight, that may indicate that the patient feels pain.