Back pain occurring along with abnormal lab results, weight loss or fatigue should alert clinicians to the possibility of multiple myeloma, according to research published in the Journal of the American Board of Family Medicine.
“Presenting symptoms of [multiple myeloma] are vague and nonspecific. Early detection poses a diagnostic challenge in primary care,” Neta Goldschmidt, MD, of the department of hematology, Hadassah-Hebrew University Medical Center in Jerusalem, Israel, and colleagues wrote. “We sought to identify ‘red flags’ that should alarm physicians that [multiple myeloma] is the cause of the symptoms and signs.”
Researchers wrote that although back pain is the second most common reason patients consult their primary care physician, fewer than 1% of these cases are related to malignancy, and the average primary care physician may see fewer than 10 cases of multiple myeloma in their professional career.
Goldschmidt and colleagues conducted a retrospective population-based study of 110 patients with multiple myeloma between 2002 and 2011, and matched cancer-free controls with low back pain. Laboratory and clinical data were extracted from medical records for the 2-year period prior to diagnosis of multiple myeloma, or of back pain in the controls. During that time window, 37 patients with multiple myeloma experienced weight loss or fatigue and 64 experienced back pain. There was no significant difference in pain complaints among the case-controls.
In a multivariate analysis, fatigue, weight loss, anemia, elevated erythrocyte sedimentation rate and creatinine were more frequent in patients with multiple myeloma compared with controls (P < 0.001 for all). “Given the changing clinical course of [multiple myeloma], recommendations for early treatment of smoldering myeloma, and calls for screening using free light chain levels, it is important to repeat this study in larger populations and in other clinical settings to determine whether there is justification for a policy recommending early detection of [multiple myeloma],” Goldschmidt and colleagues wrote. – by Janel Miller