Side effects of analgesia may significantly reduce quality of life in symptomatic multiple myeloma: a cross-sectional prevalence study

Background Pain is a common symptom in patients with multiple myeloma (MM). Many patients are dependent on analgesics and in particular opioids, but there is limited information on the impact of these drugs and their side effects on health-related quality of life (HRQoL). Method In a cross-sectional study, semi-structured interviews were performed in 21 patients attending the hospital with symptomatic MM on pain medications. HRQoL was measured using items 29 and 30 of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30. Results Patients were able to recall a median of two (range 0–4) analgesics. They spontaneously identified a median of two (range 1–5) side effects attributable to their analgesic medications. Patients’ assessment of HRQoL based on the EORTC QLQ-C30 questions 29/30 was mean 48.3 (95 % CI; 38.7–57.9) out of 100. Patients’ assessment of their HRQoL in the hypothetical situation, in which they would not experience any side effects from analgesics, was significantly higher: 62.6 (53.5–71.7) (t test, p=0.001). Conclusion This study provides, for the first time, evidence that side effects of analgesics are common in symptomatic MM and may result in a statistically and clinically significant reduction of self-reported HRQoL

Group median [IQR] temperature for pain stimulation and pain rating.

<p>Group median [IQR] temperature for pain stimulation and pain rating.</p

Anatomical regions showing areas where statistical significant BOLD fMRI response to heat-pain stimuli were greater than baseline temperature for Healthy Volunteers and myeloma patients with CIPN.

<p><b>*</b>Voxels  =  number of voxels exceeding threshold p<0.001, uncorrected</p

Baseline characteristics (median [IQR]) of the subjects recruited.

<p>Baseline characteristics (median [IQR]) of the subjects recruited.</p

a: CIPN-myeloma patients demonstrated activation in the operculo-insular cortex.

<p>This activation was during painful heat stimulation, the degree of which correlated with TNS-reduced version. For display purposes, the statistical threshold is p<0.001, uncorrected, at the voxel-level. <b>b: Linear correlation between the TNS-reduced version and BOLD response within the operculo-insular cortex.</b></p

CIPN-myeloma patients demonstrated a) hypo-activation of superior frontal gyrus during heat-pain stimulation, compared with healthy volunteers.

<p>Functional imaging data are shown overlaid on both axial (z = 48 mm) and sagittal (x = 6 mm) slices through a canonical single-subject T1-weighted image. For display purposes, the statistical threshold is p<0.001, uncorrected, at the voxel-level. <b>b) Contrast estimates and 90% CI at co-ordinate 6, 39, 48 for both healthy volunteer and CIPN-myeloma patient groups.</b></p

CIPN-myeloma patients demonstrated a0 hyper-activation of precuneus during heat-pain stimulation, compared with healthy volunteers.

<p>Functional imaging data are shown overlaid on both axial (z = 27 mm) and sagittal (x = −18 mm) slices through a canonical single-subject T1-weighted image. For display purposes, the statistical threshold is p<0.001, uncorrected, at the voxel-level. <b>b) Contrast estimates and 90% CI at co-ordinate −18, −61, 27 for both healthy volunteer and CIPN-myeloma patient groups.</b></p