Nonspecific Symptoms Including Back Pain Should Be Red Flags for Myeloma, Study Suggests

A combination of nonspecific symptoms, including back pain and weight loss, should alert physicians to the possibility of multiple myeloma.

Still, the recognition of symptom patterns is not likely to improve outcomes, as the study did not find any links between the time from first symptoms to diagnosis and survival, making researchers call for larger studies to determine whether recommending early detection would be legitimate.

The study, “Presenting Signs of Multiple Myeloma and the Effect of Diagnostic Delay on the Prognosis,” was published in the Journal of the American Board of Family Medicine.

In their search for early signs of multiple myeloma, researchers at the Hadassah-Hebrew University Medical Center in Israel reviewed medical records of 110 patients diagnosed with myeloma between 2002 and 2011.

Looking at the two years preceding a myeloma diagnosis, the research team specifically looked for the presence of back pain, and then identified other symptoms that may indicate that the pain was caused by myeloma.

To get reliable data, the team also looked at the records of control individuals, who had back pain but never developed cancer.

The study showed that 87 percent of patients had some type of complaint in the two years before they were diagnosed with myeloma. Back and other types of musculoskeletal pain were the most common complaints, with back pain making up 58 percent of complaints.

Also, more than half of patients had an infection in the years leading up to the diagnosis, while weight loss and fatigue were found in 9 percent and 25 percent of patients, respectively. Abnormal laboratory measures included creatinine, anemia — present in 68 percent of the tested patients — and a higher erythrocyte sedimentation rate, present in 82 percent.

An analysis weighing all the factors in patients and back-pain controls demonstrated that weight loss, fatigue, anemia, and the presence of other abnormal lab values were more likely to occur in patients than controls.

The time from first symptoms to a myeloma diagnosis was longer in older patients, but it did not impact the cancer stage at the time of diagnosis. It also had no connection to survival times or mortality rates.

Taken together, pain itself is not a warning sign for myeloma, but when it occurs with other unspecific symptoms, this should be a warning sign alerting the physician that cancer may be present.