Adam T. Schulman, MD
Resident Physician
Mount Sinai Hospital
NYC, New York, United States
Rachel M. Thompson, BS
Medical Student
UVM Larner College of Medicine
NYC, New York, United States
Carley Trentman, MD
Attending Physician
Mount Sinai Hospital
NYC, New York, United States
Nociceptive pain in multiple myeloma
Case Description:
A 51-year-old male with no relevant past medical history presented with atraumatic lower back pain for 2 weeks. His blood work was significant for hypercalcemia, anemia, and an AKI. CT of his spine revealed innumerable, diffuse lytic lesions, multiple acute compression fractures (most significant at T5, T7, L2, and L3), and an extraosseous tumor at T9 (with mild canal stenosis). Multiple myeloma was confirmed by pathology after bone marrow biopsy. Due to persistent pain despite aggressive pain control and IV steroids, the patient was offered palliative kyphoplasty. He underwent L1, L2, and L3 kyphoplasty with symptomatic improvement. However his mid back pain became more noticeable now that his lumbar pain was managed. One week later, he underwent T3, T4, T5, T6, T7, T10 kyphoplasty. His pain was much better controlled, and the patient was able to comfortably participate in therapy.
Discussions:
This case emphasizes the growing recognition of kyphoplasty’s role in palliative care for pathologic fractures, particularly when it is an oncologic cause such as multiple myeloma. As supported by recent consensus, kyphoplasty is effective for pain relief, functional restoration, and stabilization in patients with vertebral compression fractures due to myeloma. By reducing the need for opioids and improving mobility, it facilitates quicker rehabilitation courses and better quality of life. Kyphoplasty, typically within 4–8 weeks of vertebral compression fractures, is recommended to optimize clinical outcomes, enhance functional recovery, and improve patient participation in rehabilitative therapies. Timely integration of kyphoplasty into cancer care offers sustained benefits with minimal risks compared to conservative or non-surgical management.
Conclusions:
Kyphoplasty is a minimally invasive, relatively safe, and effective palliative procedure for patients with acute, pathologic, compression fractures performed by interventional pain physicians. This case is an example of the utility of kyphoplasty in cancer related pain management.
