Coluzzi Flaminia, Rolke Roman, Mercadante Sebastiano
Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy.
Department of Palliative Medicine, Medical Faculty RWTH Aachen University, 52062 Aachen, Germany.
Cancers (Basel). 2019 Dec 17;11(12):2037. doi: 10.3390/cancers11122037.
Most patients with multiple myeloma (MM) suffer from chronic pain at every stage of the natural disease process. This review focuses on the most common causes of chronic pain in MM patients: (1) pain from myeloma bone disease (MBD); (2) chemotherapy-induced peripheral neuropathy as a possible consequence of proteasome inhibitor therapy (i.e., bortezomib-induced); (3) post-herpetic neuralgia as a possible complication of varicella zoster virus reactivation because of post-transplantation immunodepression; and (4) pain in cancer survivors, with increasing numbers due to the success of antiblastic treatments, which have significantly improved overall survival and quality of life. In this review, non-pain specialists will find an overview including a detailed description of physiopathological mechanisms underlying central sensitization and pain chronification in bone pain, the rationale for the correct use of analgesics and invasive techniques in different pain syndromes, and the most recent recommendations published on these topics. The ultimate target of this review was to underlie that different types of pain can be observed in MM patients, and highlight that only after an accurate pain assessment, clinical examination, and pain classification, can pain be safely and effectively addressed by selecting the right analgesic option for the right patient.
大多数多发性骨髓瘤（MM）患者在自然病程的每个阶段都会遭受慢性疼痛。本综述聚焦于MM患者慢性疼痛的最常见原因：（1）骨髓瘤骨病（MBD）引起的疼痛；（2）蛋白酶体抑制剂治疗（即硼替佐米诱导）可能导致的化疗引起的周围神经病变；（3）由于移植后免疫抑制，水痘带状疱疹病毒再激活可能引发的带状疱疹后神经痛；（4）癌症幸存者的疼痛，随着抗骨髓瘤治疗的成功，癌症幸存者数量增加，这些治疗显著提高了总体生存率和生活质量。在本综述中，非疼痛专科医生将看到一份概述，包括对骨痛中枢敏化和疼痛慢性化潜在生理病理机制的详细描述、在不同疼痛综合征中正确使用镇痛药和侵入性技术的基本原理，以及关于这些主题发布的最新建议。本综述的最终目的是强调MM患者可能出现不同类型的疼痛，并强调只有在进行准确的疼痛评估、临床检查和疼痛分类后，才能通过为合适的患者选择合适的镇痛方案，安全有效地解决疼痛问题。
