How Can a Patient Tell if Bone Pain Is Related to Treatment or the Myeloma Itself?
Josh Epworth:
For the treatment-related bone pain, if we're talking about the bone pain that occurs with the infusions of Zometa (zoledronic acid) or other bisphosphonates, which are bone strengthening agents, what we're looking at is that this would go in conjunction with the infusion itself for a short time after. In addition, it's a more universal type bone pain, meaning covering a multitude of joints and bones as opposed to a single site.
How Can Bone Pain Be Treated?
Josh Epworth:
It depends on the location and the severity of it, when we look at bone pain for a patient and we have to look at it both as an acute and a chronic issue. For instance, if a patient has lytic lesion or fracture, that is, has an inflammatory quality, which is causing pain, a suppression of the disease through a host of different factors, which I'll go over in a minute, can reduce that pain significantly.
However, if we're talking about pain caused by bone fractures or compression of nervous systems based off of the fractures, then that's a different sort of approach. But let's take the idea from the very beginning of, we've got [a] lytic lesion that is causing pain. And the primary approach to that is the actual treatment of the disease. If we can suppress the disease, we'll see a suppression of that lytic lesion and the inflammation that goes along with it and presumably an improvement in pain. If we're not seeing despite a good effect against disease with chemotherapy alone, we can utilize our colleagues in palliative radiation, meaning that a dosed radiation to a single site to radically reduce the level of disease in that area, which can have a profound effect at reducing pain.
Now, if we're talking about fractured bones or compressed spinal column, there are still some approaches. For instance, surgical approaches to stabilize the leg. Oftentimes we'll see our colleagues in orthopedics, can provide some stabilization and support in particular to femur and humerus bones. Other opportunities if we're seeing compression fractures is the introduction of kyphoplasty, which is an introduction of a cement to the vertebra that are damaged to stabilize it, which can have a significant and almost immediate effect on pain for a certain percentage of patients. So, what it really comes down to is what's the cause of the pain, and how long has it been there, and what is our approach? Because what we look at are chemotherapy, radiation, and surgical approaches.
Does Bone Pain Treatment Ever Affect Myeloma Treatment?
Josh Epworth:
Multiple myeloma being a chronic disease is always an approach of synergy, meaning a combination of chemotherapeutic agents. We never use a single chemotherapeutic agent, it's always a combination of. And when we look at it in a broader scale, our approach is also synergistic where we're looking at these approaches of chemotherapy plus bone improvement therapy with bisphosphonates, plus, or minus, radiation therapy and surgical support.
So when we're looking at the introduction of bisphosphonates, which can have an impact on frequency of bone pain caused by lytic lesions and fractures, that goes very well in combination with our current chemotherapies. Oftentimes where we are having to put a pause on therapy is with surgical approaches where we're concerned over risk of infection or slow healing that is caused by the presentation of chemotherapy. So oftentimes we'll hold chemotherapy for a short time while we're waiting to do surgery. That said, most of the time when we're doing surgery is in either an acute thing where we have no other choice at that point or we're doing it after we have completed our primary chemotherapy approach and we can pull back for a short period of time. The same holds true for radiation therapy.
Is There Anything a Patient Can Do at Home to Strengthen Their Bones or Relieve Pain?
Josh Epworth:
It's always a great question when patients ask what can they do, because we do very much want to focus on how we can avoid disempowering the patient, meaning, we can have a tendency to come in and go, "Here's what we're going to do. You are the recipient in this."
And patients will ask a lot, "Well, what can I eat? Should I get more exercise?" And they're applying a lot of the things that they've learned in life of going, like, "If I eat right and get plenty of exercise, this outcome will be improved." When we talk about lytic lesions, we're talking about a decrease in the strength capacity of the bone. So, we can see fractures occurring for very minor traumas or a patient lifting up a certain weight. We've had a patient who broke his humerus while almost falling and waving his arms to prevent himself from falling and the humerus broken that setting.
Now those are pretty extreme factors. But what we oftentimes talk about is when we see a patient who has lytic lesions, we do have a conversation with them and saying, "Please minimize weightlifting of a maximum of 10-20 pounds depending on the provider you're talking to." And often the question will be, "Well, for how long?" And our response is, "Forever," because the fractures or the damage that occurs to the bone does not heal the way a broken bone normally would. So when patients ask what can they do, we're saying like, "Please monitor these approaches and make sure that you are minimizing your weight lifting."
In addition, when a lot of patients ask what they can do, my usual response is that while there's nothing that they can do personally, from what we know now, medically speaking, that can significantly improve the chemotherapy's approach, our take on it is, if you eat right, if you rest, if you hydrate, those are going to keep that body system functioning well so that it can tolerate what we're doing. We're not going to have to have dose holds or dose reductions based off of kidney dysfunction, that if they get a cold, that a healthy body can tolerate it better than an unhealthy body. So, when patients ask what can they do, my usual approach is, "Take your medications as ordered. Let us know if you've added anything and just take care of your body," because that's the biggest thing that they can do.
