“Pain therapy, faced with the painful outcomes of an important oncological disease such as Multiple Myeloma, has a crucial role and can support and help patients”. The encouragement, in reference to the illness that struck the pianist Giovanni Allevi who publicly declared his experience, comes from Professor Flaminia Coluzzi, Head of the Onco-Hematology Pain Therapy Center at the Sant’Andrea Hospital in Rome and Professor at the Department of Sciences and Medical-Surgical Biotechnology of the La Sapienza University of Rome.
“We read about Allevi’s suffering from broken bones. Multiple myeloma is a hematological disease that affects the plasma cells in the bone marrow. Unfortunately, unlike other types of cancer, there is no screening program, therefore it is frequent that the first manifestation of the disease it is precisely the pain caused by the fracture of an affected bone – explains Coluzzi – Despite the good possibilities of treatment from a hematological point of view, patients can suffer from severe bone pain from the onset, for which it is advisable to report them early to a pain therapy center that can support the path of treatment of the disease”. According to the expert “today we have numerous therapeutic strategies available, proposed through a multidisciplinary approach. Most of the time, however, it is the major analgesic drugs, such as opioids, that are the first frontier to start having immediate relief. We can associate cortisone and molecules that modify bone remodeling, considering that the main objective is precisely to reduce bone fractures”.
Allevi complained of difficulty in using his hands to play: “We don’t know the individual case, but we do know that patients who use some chemotherapy can undergo peripheral neuropathies induced by chemotherapy”. These neuropathies are caused by the systemic toxic effects of the molecules used and mainly affect small caliber peripheral nerve fibres. Neuropathies are painful, he adds, “but we are dealing with a pain that is different from bone pain. Patients present with symptoms characteristic of a form of pain that we define as “neuropathic” precisely because it originates from a lesion of the nervous system, in this case peripheral. Patients complain of pins and needles, pins and needles, electric shocks, even if there is actually none of these stimuli.They have difficulty in fine movements, such as tying shoes, buttoning a shirt or handling money.What is important to emphasize is that it is a “pathological” pain, which is accompanied by functional and structural modifications of the central nervous system, fueled by the release of inflammatory cytokines which lead to neuroinflammation and facilitate the transmission of pain”.
It must be considered that at the level of the central nervous system, he clarifies, “a series of modifications occur that alter pain perceptions. Non-neuronal cells, such as microglia, also participate in these neuroinflammatory processes. Therefore, drugs are used that reduce the release of excitatory neurotransmitters by sensory neurons, others that enhance the physiological mechanisms of analgesia that our body has at its disposal and molecules that modulate the hyperexcitability of the cells that fuel neuro-inflammation”, says the expert.
Can we give patients suffering from myeloma or other forms of cancer pain hope for a better quality of life? “Restoring a good quality of life is the main objective that we set for ourselves in a pain therapy centre, but it is essential that patients are sent to us early. Today, pain therapy centers have grown extensively in Italy and can provide a valid support throughout the natural history of the oncological disease.It is important to identify not only the extent of the pain, but its type, in order to be able to treat it with the most suitable molecules, which are not necessarily the classic analgesics that we are used to using in acute pain”, concludes Coluzzi.