Towards a better understanding of the relationship between side effects of analgesia and quality of life in patients with multiple myeloma.

Abstract

Dear Editor, The paper by S. Sloot and colleagues [1], published in a recent issue of the journal Support Care Cancer, reported novel and interesting findings, raising important questions on side effects of analgesic therapy in patients with multiple myeloma (MM) and their relationship with quality of life (QoL). Although, in the last decade, the introduction of more effective disease-targeted agents and the improvement of supportive therapies have substantially changed the clinical scenario, pain management still remains a critical issue in MM patients [2], which may suffer from several and difficult-to-treat pain syndromes at any time during the course of disease [2]. Therefore, appropriate pain treatment is an essential component of the global management of MM patients and should consider various approaches such as causal therapies and adjuvant measures, including bisphosphonates, radiotherapy and surgical interventions [2]. Analgesic therapy represents an important component of a global and integrated strategy for pain relief in most MM patients and remains sometimes the only applicable measure in those with advanced phase of disease [2–4]. Optimization of use of analgesics and management of associated side effects is critical as it might impact patients’ QoL [3, 5]. S. Sloot and colleagues [1] examined a sample of 21 symptomatic MM patients with a mean age 65 years to determine whether their global QoL was affected by analgesic-related side effects. The most frequently used pain medication by these patients was paracetamol. With the help of prompt sheets, patients themselves were able to recall having used a median of three (range 1–7) analgesics and a median of two (range 1–8) side effects related to their use of analgesics. To assess QoL, the authors used the global health status/ QoL scale (i.e., items 29 and 30) of the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire-Core 30 (EORTC QLQC30). A key result of this study was that side effects of analgesics are common in symptomatic MM and may result in a statistically and clinically significant detrimental effect on QoL [1]. There is paucity of studies investigating the multifaceted relationship between pain, use of analgesics, and overall QoL; thus, the authors are bridging an important gap in the scientific literature. However, along with the study limitations that the authors have clearly detailed in the discussion, we feel that it is important to further highlight some issues that could be further addressed in future reports investigating this issue. Indeed, the investigation of some additional aspects that was not possible to address in this study due to the lack of a control group could bring new insights in future works. For example, is pain intensity reported by patients who experience side effects (from analgesics) more severe compared to those who do not? Pain is one of the most frequently reported compliant in MM patients, and its intensity and the related mood disturbance are significant predictors of reduced patient’s QoL [3]. So, what relationship could be likely supposed by the authors between the pain at baseline and side effects of analgesia? Again, * Pasquale Niscola pniscola@gmail.com