Multiple myeloma is the term for cancer of the plasma cells, a type of white blood cell that fights infection. The disease causes the body to produce too many plasma cells inside the bone marrow, which can cause tumors to develop. A common symptom of multiple myeloma is pain in certain areas of the body.

Plasma cells are a type of white blood cell present in the bone marrow. These cells are an important part of the immune system, as they produce antibodies and fight infection. In people with multiple myeloma, the body produces too many plasma cells in the bone marrow.

This overproduction of plasma cells can result in complications that lead to painful symptoms. Common sources of pain typically include weakening of the bones, a tumor pressing against a nerve, and certain infections. A pain management program can help identify the exact cause and location of discomfort, and appropriate treatments can help relieve the symptoms.

In this article, we discuss common sources of multiple myeloma pain and the treatment options that may help people manage the symptoms.

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Chronic pain is a common symptom of multiple myeloma. People with multiple myeloma experience pain as a result of various factors, but common causes include:

Bone disease

Bone disease is a common symptom of multiple myeloma. About 80% of people have bone disease when they receive their multiple myeloma diagnosis. In a healthy skeleton, the bones are continually regenerating through a process known as bone remodeling. This is when old bone tissue breaks down, and new bone tissue replaces it.

Two types of cells play an important role in bone regeneration: osteoclasts and osteoblasts. Osteoclasts help break down old bone tissue, while osteoblasts play a role in the formation of new bone tissue. These two cells work in a balanced way to maintain bone health.

Multiple myeloma can disrupt the balance of this process. It can cause the body to produce osteoclast-activating factors and inhibit the formation of osteoblast cells. This can result in too much bone breakdown and insufficient bone buildup. The combination of these effects can weaken the bone and cause painful symptoms, such as fractures and lytic bone lesions.

Neuropathic pain

Damage to the nerves or pressure on them can cause a person to experience pain. This type of pain is known as neuropathic pain. Some people with neuropathic pain experience chronic pain in their body that feels like a sharp, burning sensation. Others experience numbness or a tingling sensation. Neuropathic pain may also make it difficult to perform certain tasks, such as fastening buttons or opening jars.

Multiple myeloma can cause neuropathic pain in various ways, including:

  • Vertebral compression fractures: If a person has multiple myeloma-related bone disease in their vertebrae, they may end up with compression fractures in their spine. These fractures can impact the spinal cord, which can cause neuropathic pain.
  • Certain treatments: Some drugs for multiple myeloma can result in neuropathy or make preexisting neuropathy worse. For example, a common side effect of bortezomib, a well-established treatment for multiple myeloma, is neuropathic pain.
  • Monoclonal proteins: Multiple myeloma can cause a person to develop an increase in monoclonal proteins, known as paraproteins. These are abnormal immunoglobulin cells that do not properly fight infection. They can affect a person’s nerve cells, causing neuropathic pain.


Certain treatments for multiple myeloma and the disease itself can cause a person’s immune system to become weaker. These medications can increase a person’s risk of infection from the varicella-zoster virus (VZV). Infection with VZV can result in shingles.

Shingles causes a person to develop a painful rash on one side of their face or body. The rash often consists of blisters that scab over before they clear up. Common symptoms of shingles include:

  • a painful rash
  • blister-like sores
  • fever
  • headaches
  • chills
  • upset stomach

Multiple myeloma pain can affect many different parts of the body.

For example, if a person has bone disease due to multiple myeloma, they may experience pain in a number of places. Bone lesions occur in 80–90% of people with multiple myeloma. The bones that multiple myeloma most commonly affects are the ones present in a person’s back. Other bones that it typically affects are the:

  • pelvis
  • ribs
  • long bones in the arms and legs

Neuropathic pain can also affect several different parts of the body. If a person has neuropathic pain related to multiple myeloma, it often causes peripheral neuropathy. This refers to pain in the peripheral nervous system, meaning that a person may experience pain in their face, arms, and legs.

Shingles usually affects one side of the body, often causing symptoms on the waist, chest, abdomen, or back. The symptoms can appear on the face, and they can also affect some internal organs.

Shingles typically affects a single sensory nerve ganglion near the spinal cord, known as a dorsal root ganglion. This is why the symptoms occur in specific areas rather than all over the body. The pain results from nerve involvement rather than the rash itself.

Chronic pain is one of the main symptoms of multiple myeloma. However, a person may develop a few other symptoms. Other common symptoms of multiple myeloma include:

  • bones that break easily
  • fever
  • increased infections
  • easy bruising
  • easy bleeding
  • problems breathing
  • weak arms or legs
  • fatigue

Multiple myeloma may also cause a person to develop too much calcium in their blood, which is known as hypercalcemia. This can affect a person’s organs, including the kidneys, the nerves, the heart, and the organs in the digestive tract. Common symptoms of hypercalcemia include:

  • thirst
  • nausea and vomiting
  • increased urination
  • constipation
  • fatigue
  • weakness
  • pain
  • confusion

Below are some of the ways a person can treat their multiple myeloma pain.

Pain relief medications

A doctor may prescribe pain relievers to manage bone pain related to multiple myeloma. These pain medications may include:

Radiation therapy

Radiation therapy is a treatment that uses radiation to destroy or shrink cancer cells and tumors.

Radiation therapy is a highly effective treatment for bone pain, and 85% of individuals report improvements in pain after treatment. The response to this treatment is usually fast, with 50% of people reporting pain relief within the first 2 weeks of therapy.

Vertebroplasty and kyphoplasty

If a person has fractures in their vertebrae, they may require a vertebroplasty or a kyphoplasty.

During a vertebroplasty, a doctor injects bone cement into the affected vertebrae to repair and strengthen the bone. This is a minimally invasive procedure. A kyphoplasty is a similar procedure, but a doctor will place an inflatable balloon into the vertebrae before they inject the bone cement.

Both of these treatments typically work well for people with vertebral compression fractures. They can both provide effective pain relief, better mobility, and improved performance.


Corticosteroids can help fight tumors and control inflammation. Corticosteroids such as prednisone (Deltasone) and dexamethasone (Decadron) often feature in treatment regimens for multiple myeloma.

Research suggests that 30–70% of people experience effective pain relief with corticosteroids. However, these drugs are particularly effective in reducing pain flares during radiation therapy for people with bone pain.

Treating neuropathic pain

Doctors may treat neuropathic pain with anticonvulsant drugs, such as gabapentin (Neurontin) and pregabalin (Lyrica). A person may also wish to use topical ointments, such as capsaicin cream. If pressure on a nerve is causing the pain, a person may require surgery to relieve the pressure and reduce pain.

Sometimes, other multiple myeloma treatments can cause neuropathic pain. If this is the case, a doctor may recommend that the person stop their treatment for a time or change their dosage.

A person with neuropathic pain may also wish to undertake regular exercise, which can improve circulation and reduce pain. They can try walking, swimming, or gentle yoga or tai chi. Stopping smoking and reducing alcohol consumption, if applicable, can also help reduce neuropathic pain.

Treating shingles pain

A person may wish to treat their shingles with antiviral medications. These can shorten the length and severity of the infection. A person should take these medications as soon as their rash appears.

Over-the-counter or prescription pain relievers may also help reduce pain. Other treatment options include wet compresses, calamine lotion, and colloidal oatmeal baths.

Multiple myeloma is a cancer of the plasma cells, and chronic pain is a common symptom of this condition. There are various possible causes of chronic pain in people with multiple myeloma. These include bone pain due to bone disease, neuropathic pain, and pain from shingles.

A doctor can identify the cause of pain and prescribe appropriate treatment. Depending on the exact cause, the treatment options can include pain medications, radiation therapy, surgery, anticonvulsants, and antiviral treatments.