[dw10018]

Myalgia-rib pain?

by dw10018 on Tue May 24, 2011 2:43 pm

Drs. Siegel and Vesole, thank you for taking time to answer questions in the forum

I'm a 52 yr WM, WPB Florida diagnosed in Apr/08 w/ IGA multiple myeloma. Since that time I've maintained a very good partial remission with the use of Revlimid(rev) and Velcade(vel) and dex. Sarted on rev/dex, became refractory after having swine flu. Moved to Velcade for six cycles had to stop due to foot neuropathy. Went back rev/dex, then again became refractory. Now on cycle number four of rev/dex/vel. So far so good. My only bone involvement has been a isolated plasmacytoma removed from skull on initial diagnosis-08 and a small pathologic R rib fx noted on PET/CT-09. I take Zometa only quaterly due to the week long bone/muscle pain//fever it causes.

Since the rib fx, which was radiated, I continue to experience intermittent intense rib and scapular muscle pain. Yet each time a scan is done nothing shows up. The rib pain is difuse, but at times it' s point tender. Currently I'm experiencing pain L lateral ribs and point tenderness near the xyphoid process and connecting ribs. I workout twice a week, yoga and deep breathing daily. I can't run any more due to the rib discomfort . I stll work a few days a week PRN as a respiratory therapist. My oncologist says it's costochondritis and myalgia. This has been going on for quite awhile. This most current episode has lasted over two months. Pain meds just make me sleepy and since my liver enzymes have been elevated lately I try to stay away from the NSAIDs.

I thought this pain could be due to the rev/dex/vel combo,because I never experienced this while just being on rev or vel-- but I'm on my break and the pain is just the same. I'm trying not to run after these symptoms w/ scan after scan.


Thanks in advance for your thoughts/response.

Dean

[Dr. David Vesole]

Re: Myalgia-rib pain?

by Dr. David Vesole on Wed May 25, 2011 3:25 pm

It is unlikely that the myalgias/arthralgias are contributing to your pain syndrome. That being stated, RARELY, Velcade can cause atypical pain syndromes. It may be worthwhile to start a trial of some of the agents we utilize for chemotherapy associated neuropathy such as Cymbalta or Neurontin/Lyrica.

You are very young. I assume your primary oncologist has recommended you see a stem cell transplant specialist. In Florida, the main myeloma experts are in Tampa (Moffitt) and in Jacksonville (Mayo).