Understanding Lesions and Bone Pain In Multiple Myeloma

A type of blood cancer, multiple myeloma affects the plasma cells of the body, which protect the body against infection. Plasma cells are made in the bone marrow and this is why myeloma cancer cells are able to multiply at a rapid pace and spread throughout the body wherever bone marrow is present. Over a period of time, the cancer cells finish off the healthy plasma cells and the other blood cells in the bone marrow. Myeloma cancer cells also start producing abnormal antibodies in the body, which leads to a slowing down of the blood flow. This condition leads to the existence of multiple tumors or lesions. Also known as lytic or osteolytic lesions, these tumors cause bone damage in the parts they grow in, causing you to feel pain. However, many people often fail to understand bone pain in multiple myeloma properly and are therefore unable to address the pain in the right manner. Let us take a moment to understand lesions and bone pain in multiple myeloma cases.

Understanding Lesions and Bone Pain In Multiple Myeloma

What are Lytic Lesions in Multiple Myeloma?

If you suffer from multiple myeloma, then you have cancerous cells growing inside your bone marrow. These malignant plasma cells are white blood cells that are capable of making antibodies since they are a part of your immune system and before being affected by the cancer, they were primarily responsible for fighting off infections.

Lytic lesions are the areas of bone damage that have been caused by these cancerous plasma cells that are growing in the bone marrow. Lytic lesions are also known as bone lesions or osteolytic lesions. When you have myeloma, your bones are no longer able to break down and then regrow as they should, which causes them to become thin and also gives rise to certain areas of abnormal bone. Anyone who has multiple myeloma will end up having bone lesions at some point or the other throughout the disease.

What Causes Bone Lesions in Multiple Myeloma?

In a person who does not have myeloma, a normal bone has a process for bone remodeling. This keeps your bones strong and healthy. Inside the body, the bone remodeling process begins with certain specialized cells known as osteoclasts breaking down the old bones. Osteoblasts, another type of specialized cells, then lay down the foundation of a new bone in its place.

However, in people affected by multiple myeloma, the cancerous plasma cells, also known as myeloma cells, produce certain chemicals that are known as osteoclast activating factors (OAFs). These osteoclast activating factors signal the osteoclasts to start breaking down the bones faster than usual. When this happens, the old bone gets broken down rapidly, but there is no new bone to take its place as the new bone is still manufactured by the osteoblasts at the same pace. This disruption of the natural process causes bone lesions and they are likely to weaken your bones and also make them more susceptible to break and fractures.

Where Do Bone Lesions Develop in Multiple Myeloma?

Bone lesions can occur at any place where bone marrow exists, including- ribs, hips, shoulders, pelvic bones and spine. Bone pain is also the most common symptom that arises from the formation of these bone lesions.

What are the Causes of Multiple Myeloma Bone Pain?

Multiple myeloma causes bone lesions to develop as mentioned above. These bone lesions show up on an x-ray in the form of holes. Bone lesions are very painful and also increase the risk of having painful fractures or breaks.

Another reason for experiencing bone pain in multiple myeloma is that the cancer can also damage the nerves. You may also feel pain when a bone lesion presses up against a nerve. These bone lesions can also compress your spinal cord, causing muscle weakness and severe back pain.

You are likely to feel pain when you move, but not when you stay still. In multiple myeloma, you may feel bone pain in your- legs, hips, back, chest, pelvis, arms, skull, teeth, jaw and belly.

Statistics from the Multiple Myeloma Research Foundation shows that nearly 85% of all patients having multiple myeloma are going to experience some form of bone loss and bone pain associated with this.

What are the Treatments for Bone Lesions and Bone Pain in Multiple Myeloma?

Multiple myeloma is a painful condition and while your doctor’s first priority will be to treat the cancer itself, you will also be given several treatment options for relieving your bone pain from the bone lesions of multiple myeloma. There are natural and medical options available for treating bone lesions and bone pain. Pain treatments will help you get relief from the bone pain in multiple myeloma, but keep in mind that they will not stop the progression of the disease. However, you should never start any treatment or medication without consulting your doctor.

Medical Treatment Options for Bone Pain in Multiple Myeloma

Some of the medical treatment options for bone lesions and bone pain include-

Pain Relievers- The most commonly used treatment for dealing with bone pain of multiple myeloma is to take analgesics or pain relievers. Most common pain relievers for treating bone pain are narcotics and opioids, for example, codeine or morphine. These are prescription drugs and you cannot begin treatment with these analgesics without the consent of your doctor.

Antidepressants & Anticonvulsants- Surprising as it may sound, antidepressants and anticonvulsants are also sometimes used for treating bone pain that is caused by nerve damage in multiple myeloma. This is because these medications can help slow down or interrupt the pain signals that are being sent by the nerve cells to the brain.

Bisphosphonates- These are prescription drugs that inhibit the bone cells from breaking down, thus damaging the bone. You can either receive these intravenously through a vein or you can also take them orally to relieve bone lesions and bone pain in multiple myeloma.

Radiation Therapy- Radiation therapy helps shrink the bone lesions and can help provide pain relief from compressed spinal cords or pinched nerves.

Surgery- You will require surgery for fractures or bone breaks in multiple myeloma. Your doctor may also recommend you to undergo surgery if you need to have rods or plates inserted to support certain weakened or fragile bones.

Natural Treatment Options for Bone Pain in Multiple Myeloma

There are many natural treatment options also that you can use along with your medical treatments including medications and surgery for alleviating bone pain in multiple myeloma. Some natural treatments can provide quite a bit of relief in the bone pain of multiple myeloma. These include-

Acupuncture– This is a safe treatment option that promotes nerve health, which is something you can really use if you are suffering from multiple myeloma and its associated bone pain. Acupuncture also helps with bone pain, providing strong pain relief.

Physical Therapy– This includes general strength building exercises which help you strengthen the affected part of the body that has bone damage or the part that has undergone surgery. Physical therapy can also help you expand your range of motion.

Massage Therapy– Helps relieve joint, muscle, and bone pain, but over a period of time.


Multiple myeloma is a serious condition and the resulting bone damage can cause many types of serious and long-lasting effects, such as bone pain and bone weakness. The bone lesions that occur due to multiple myeloma are not only difficult to treat, but they also increase the risk of bone fractures and the bone breaks significantly, even when the cancer goes into remission.

Make sure to discuss your condition openly with your doctor and seek help when you are in pain. There are many treatments available to offer pain relief, including Cymbalta (duloxetine) and Lyrica (pregabalin). Wearing loose socks, padded slippers, and walking regularly will also help in relieving your bone pain in multiple myeloma.

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:September 22, 2021

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