Chest pain in the course of multiple myeloma - a clinical case study

Marcin Drab, Agnieszka Szymczyk, Waldemar Tomczak, Elżbieta Drab-Urbanek, Katarzyna Łapacz, Marek Hus, Monika Podhorecka

Abstract


Introduction: Multiple myeloma (MM) is a rare blood cell proliferative disease characterized by the accumulation and proliferation of monoclonal plasmocytes. Clinical picture of MM includes bone pain, underlying osteolytic lesions, osteopenia or osteoporosis that often lead to pathological fractures.
Aim: To draw attention to the unusual cause of chest pain and the holistic approach to analgesic therapy in patients with MM.
Case report: A clinical case of a 66-year-old patient with chest pain intensified when moving and deep breathing was presented and cardiological and gastroenterological reasons were excluded. Initially, non-steroidal analgesics and weak opioids were used in the treatment with good effect, however, as time was passing the pain symptoms progressed.
Diagnostic imaging was complemented by computed tomography which revealed massive destructive changes within the ribs with the presence of soft tissue masses infiltrating adjacent muscles. Based on additional tests, the patient was diagnosed with MM. Optimization of analgesic therapy has brought permanent pain relief and improved his quality of life.
Summary: The modern approach to anelgesia in patients with MM includes not only the use of analgesics, but also radiotherapy, bisphosphonates/zoledronic acid, orthopaedic treatment and chemotherapy.

Keywords


multiple myeloma; chest pain; cancer pain

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DOI: http://dx.doi.org/10.5281/zenodo.1256175

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Krishtal', N. V., Gozhenko, A. I., & Gareeva, E. G. (1994). Mechanisms of renal adaptation to disorders of water-electrolyte balance in metabolic acidosis. [Mekhanizmy pochechnoǐ adaptatsii k narusheniiam vodno-élektrolitnogo obmena pri metabolicheskom atsidoze.] Patologicheskaya Fiziologiya i Eksperimentalnaya Terapiya, (3), 42-44. Retrieved from www.scopus.com

Kryshtal, M. V., Hareieva, E. H., & Hozhenko, A. I. (1993). Response and endocrine mechanisms in the kidney effected by sodium chloride. [Reaktsiia nyrok na hostre navantazhennia natriiem khlorydom ta ǐǐ endokrynni makhanizmy.] Fiziologicheskii Zhurnal, 39(5-6), 56-60. Retrieved from www.scopus.com

Kucher, V. I., Terenozhkina, N. P., & Gozhenko, A. I. (1983). Isolation of fractions containing natriuretic hormone from blood plasma and their testing in in vivo and in vitro experiments. [Vuydelenie iz plazmy krovi fraktsiǐ, soderzhashchikh natriǐureticheskiǐ gormon, i ikh testirovanie v opytakh in vivo i in vitro.] Problemy Endokrinologii, 29(3), 47-50. Retrieved from www.scopus.com

Kukharchuk, A. L., & Gozhenko, A. I. (1985). Effect of progesterone on ion-regulating kidney function. Problemy Endokrinologii, 31(2), 55-58. Retrieved from www.scopus.com

Kukharchuk, A. L., Gozhenko, A. I., Lille Yu., E., & Loppe, M. (1992). Effect of prostacyclin and its synthetic analogue MM-706 on renal function in sublimate nephropathy. Experimental and Clinical Pharmacology, 55(5), 36-39. Retrieved from www.scopus.com

Kukharchuk, A. L., Gozhenko, A. I., Lille Yu., E., & Loppe, M. (1992). Influence of prostacycline synthetic analogue on the renal function and the blood aggregate state regulation system in experimental acute renal insufficiency. Gematologiya i Transfuziologiya, 37(9-10), 23-25. Retrieved from www.scopus.com

Kukharchuk, A. L., Gozhenko, A. I., Lille, I. E., & Loppe, M. (1992). The effect of prostacyclin and its synthetic analog MM-706 on kidney function in corrosive sublimate-induced nephropathy. [Vliianie prostatsiklina i ego sinteticheskogo analoga MM-706 na funktsional'noe sostoianie pochek pri sulemovoǐ nefropatii.] Eksperimental"Naia i Klinicheskaia Farmakologiia, 55(5), 36-39. Retrieved from www.scopus.com

Lobenko, A. A., Gozhenko, A. I., Kokhno, I. S., Gul'chenko, I. I., Grinchenko, P. A., & Osipova, E. R. (1996). The rate of healing of an ulcerous defect in the duodenal bulb in relation to the site (based on video endoscopic data). [Skorost' zazhivleniia iazvennogo defekta lukovitsy dvenadtsatiperstnoi kishki v zavisimosti ot lokalizatsii (po dannym videoéndoskopii).] Likars'Ka Sprava / Ministerstvo Okhorony Zdorov'Ia Ukraïny, (10-12), 117-119. Retrieved from www.scopus.com

Lobenko, A. A., Gozhenko, A. I., & Mishchenko, V. V. (1999). Dynamic radiation telethermometry in the diagnosis of acute appendicitis. [Distantsionnaia radiatsionnaia dinamicheskaia teplometriia v diagnostike ostrogo appenditsita.] Likars'Ka Sprava / Ministerstvo Okhorony Zdorov'Ia Ukraïny, (3), 103-106. Retrieved from www.scopus.com

Lobenko, A. A., Gozhenko, A. I., & Vasil'ev, V. A. (1995). The efficacy of metabolic therapy in chronic gastritis with secretory deficiency in flight personnel. [Effektivnost' metabolicheskoi terapii pri khronicheskom gastrite s sekretornoi nedostatochnost'iu u lits letno-pod''emnogo sostava.] Likars'Ka Sprava / Ministerstvo Okhorony Zdorov'Ia Ukraïny, (9-12), 175-179. Retrieved from www.scopus.com

Lobenko, A. A., Gozhenko, A. I., & Vasil'ev, V. A. (1997). The use of otsid in treating patients with chronic gastroduodenitis and duodenal peptic ulcer. [Primenenie otsida v lechenii bol'nykh khronicheskim gastroduodenitom i iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.] Likars'Ka Sprava / Ministerstvo Okhorony Zdorov'Ia Ukraïny, (4), 118-121. Retrieved from www.scopus.com

Lobenko, A. A., Tarabrin, O. A., Zaporozhchenko, B. S., Gozhenko, A. I., & Kiriliuk, A. A. (1998). The method of integral estimation of a functional status of the hemostatic system. [Sposob integral'noi otsenki funktsional'nogo sostoianiia sistemy gemostaza.] Klinichna Khirurhiia / Ministerstvo Okhorony Zdorov'Ia Ukraïny, Naukove Tovarystvo Khirurhiv Ukraïny, (7), 30-32. Retrieved from www.scopus.com

Milkov, B. O., Gozhenko, A. I., & Shamrei, G. P. (1987). Diagnosis of acute appendicitis with the use of remote heat flow meter based on anisotropic thermoelements. Klinicheskaya Khirurgiya, No. 4, 28-29. Retrieved from www.scopus.com

Mishcheriakova, N. G., Klenov, V. A., Sviridova, T. G., Khaǐrullina, A. B., & Gozhenko, A. I. (1995). Effects of vanadium on the physical-chemical properties of peripheral blood erythrocytes in rats. [Izuchenie vliianiia vanadiia na nekotorye fiziko-khimicheskikh svoǐstva éritrotsitov perefericheskoǐ krovi krys.] Voprosy Pitaniia, (1), 24-26. Retrieved from www.scopus.com

Mokienko, A. V., Petrenko, N. F., & Gozhenko, A. I. (2015). Hygienic estimation of biocide actions of ozone at water disinfecting. Water and Ecology, 1, 19-25. Retrieved from www.scopus.com

Nabukhotnyǐ, T. K., Pavliuk, V. P., Gozhenko, A. I., & Kukharchuk, A. L. (1987). Role of breast feeding in providing the newborn infant with thyroid hormones. [Rol' estestvennogo vskarmlivaniia v obespechenii organizma novorozhdennogo gormonami shchitovidnoǐ zhelezy.] Voprosy Pitaniia, (1), 29-31. Retrieved from www.scopus.com

Rakhmanin, I. A., Petrenko, N. F., Mokienko, A. V., & Gozhenko, A. I. (2007). Chlorine dioxide as an agent for optimization of drinking water preparation. Gigiena i Sanitariia, (6), 11-13. Retrieved from www.scopus.com

Rogovoǐ, I. E., & Gozhenko, A. I. (1989). Pathogenetic significance of lipid peroxidation in damage of the proximal segment of the nephron in acute masugi's nephritis. [Patogeneticheskoe znachenie perekisnogo okisleniia lipidov v povrezhdenii proksima'lnogo otdela nefrona pri ostrom nefrite Lindemana-Mazugi.] Fiziologicheskii Zhurnal, 35(5), 18-23. Retrieved from www.scopus.com

Sahach, V. F., Shymans'ka, T. V., Zul'fiharov, O. S., Ovchynnikova, O. H., & Hozhenko, A. I. (1999). The effect of a grape extract on the contractile activity of the myocardium and on the coronary flow of the isolated guinea pig heart. [Vplyv ekstraktu vynohradu na skorotlyvu aktyvnist' miokarda ta koronarnyi potik izol'ovanoho sertsia mors'koï svynky.] Fiziolohichnyi Zhurnal (Kiev, Ukraine : 1994), 45(5), 117-121. Retrieved from www.scopus.com

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Ye Babelyuk, V., Dubkova, G. I., Korolyshyn, T. A., Holubinka, S. M., Dobrovol’S’Kyi, Y. G., Zukow, W., . . . Popovych, I. L. (2017). Operator of kyokushin karate via kates increases synaptic efficacy in the rat hippocampus, decreases C3-θ-rhythm SPD and HRV vagal markers, increases virtual chakras energy in healthy humans as well as luminosity of distilled water in vitro. preliminary communication. Journal of Physical Education and Sport, 17(1), 383-393. 10.7752/jpes.2017.01057

Zaporozhan, V. M., Gozhenko, A. I., & Gerasymova, L. V. (2001). The kiev period of the scientific activities of V. V. pidvysots'kyi. [Kyïvs'kyi period naukovoï diial'nosti V. V. Pidvysots'kogo.] Fiziolohichnyi Zhurnal (Kiev, Ukraine : 1994), 47(1), 133-138. Retrieved from www.scopus.com

Zaporozhan, V. M., & Hozhenko, A. I. (2000). Clinical pathophysiology: Current status, problems and future development. [Klinichna patofiziolohiia: suchasnyi stan, problemy ta perspektyvy rozvytku.] Fiziolohichnyi Zhurnal (Kiev, Ukraine : 1994), 46(6), 123-126. Retrieved from www.scopus.com

Zaporozhan, V. M., Hozhenko, A. I., Svirs'kyi, O. O., & Zalins'kyi, O. O. (2000). The hormonal factors regulating water-electrolyte exchange in the pathogenesis of the hemodynamic disorders in pre-eclampsia. [Hormonal'ni faktory rehuliatsiï vodno-elektrolitnoho obminu v patohenezi porushen' hemodynamiky pry preeklampsï.] Fiziolohichnyi Zhurnal (Kiev, Ukraine : 1994), 46(2), 48-54. Retrieved from www.scopus.com

Zaporozhan, V. M., Nasibullin, B. A., Hozhenko, A. I., & Shapranov, R. A. (2002). Effects of hypogeomagnetic fields on the structural-functional activity of rat cerebral cortex. [Vplyv hipoheomahnitnoho polia na strukturno-funktisonal'ni koreliaty kory holovnoho mozku shchuriv.] Fiziolohichnyi Zhurnal (Kiev, Ukraine : 1994), 48(3), 16-21. Retrieved from www.scopus.com

Zaporozhan, V. N., Gozhenko, A. I., Dolomatov, S. I., Dolomatova, E. A., Topor, E. A., & Badyin, I. Y. (2004). Renal mechanisms of the osmotic homeostasis maintenance on a background of the salt test.Aviakosmicheskaya i Ekologicheskaya Meditsina, 38(5), 58-59. Retrieved from www.scopus.com

Zaporozhan, V. N., Gozhenko, A. I., Korneenko, T. V., & Dubinina, V. G. (2004). Role of nitric oxide in tumor growth. [Biologicheskaia aktivnost' oksida azota v mekhanizmakh opukholevogo rosta.] Uspekhi Fiziologicheskikh Nauk, 35(1), 66-82. Retrieved from www.scopus.com

 

Napierała M References in Scopus

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Dolomatov, S. I., Kubyshkin, A. V., Zukow, W. A., Kutia, S. A., Cieslicka, M., Muszkieta, R., & Napierala, M. (2014). Prospects for the replenishment of a feed protein deficit in aquaculture. Russian Journal of Marine Biology, 40(4), 233-240. 10.1134/S106307401404004X

Dragomiretskaya, N., Izha, A., Kalinichenko, N., Szark-Eckardt, M., Klimczyk, M., Cieślicka, M., . . . Zukow, W. (2015). Use of antiviral therapy in patients with chronic hepatitis C. Open Medicine (Poland), 10(1), 209-215. 10.1515/med-2015-0032

Eksterowicz, J., & Napierała, M. (2008). Evaluation of the way of nutrition of the physical education students during summer sports camp. [Ocena sposobu zywienia studentek z kierunku wychowania fizycznego podczas letniego obozu sportowego.] Roczniki Państwowego Zakładu Higieny, 59(1), 75-82. Retrieved from www.scopus.com

Eksterowicz, J., Napierała, M., & Zukow, W. (2016). How the kenyan runner's body structure affects sports results. Human Movement, 17(1), 8-14. 10.1515/humo-2016-0002

Napierała, M., & Nowicki, G. (2004). Recreational activities of bydgoszcz youth at the age of pubescence. [Wypoczynek młodziezy bydgoskiej w wieku pokwitania.] Roczniki Panstwowego Zakladu Higieny, 55(3), 261-268. Retrieved from www.scopus.com

Novikov, N., Dolomatov, S., Zukow, W., Volyanskaya, A., Napierala, M., Hagner-Derengowska, M., . . . Skaliy, A. (2012). Pathogenetic mechanisms of posttraumatic fibrosis of the uterus of white rats. Central European Journal of Medicine, 7(4), 503-510. 10.2478/s11536-011-0168-0

Zukow, W., Kalisz, Z., Muszkieta, R., & Napierala, M. (2011). Acupuncture for rheumatoid arthritis: A randomized, sham-controlled clinical trial. Journal of Acupuncture and Tuina Science, 9(3), 168-172. 10.1007/s11726-011-0502-8


 

Zukow W References in Scopus

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Babelyuk, V. Y., Gozhenko, A. I., Dubkova, G. I., Korolyshyn, T. A., Kikhtan, V. V., Babelyuk, N. V., . . . Popovych, I. L. (2017). Causal relationships between the parameters of gas discharge visualization and principal neuroendocrine factors of adaptation. Journal of Physical Education and Sport, 17(2), 624-637. 10.7752/jpes.2017.02094

Chukhraev, N., Vladimirov, A., Zukow, W., Chukhraiyeva, O., & Levkovskaya, V. (2017). Combined physiotherapy of anxiety and depression disorders in dorsopathy patients. Journal of Physical Education and Sport, 17(1), 414-417. 10.7752/jpes.2017.01061

Chukhraiev, N., Zukow, W., Chukhraieva, E., & Unichenko, A. (2017). Integrative approach to reduction of excess weight. Journal of Physical Education and Sport, 17(2), 563-567. 10.7752/jpes.2017.02085

Dolomatov, S., Sataieva, T., Pazovsky, G., & Zukow, W. (2017). Neuroendocrine effects of helminthiases (A review). Parazitologiya, 51(2), 97-103. Retrieved from www.scopus.com

Dolomatov, S., Zukow, W., & Brudnicki, R. (2013). Role of temperature in regulation of the life cycle of temperate fish. Russian Journal of Marine Biology, 39(2), 81-91. 10.1134/S1063074013020041

Dolomatov, S., Zukow, W., Dzierzanowski, M., Mieszkowski, J., Muszkieta, R., & Klimczyk, M. (2016). Role of nitrates in the adaptation of fish to hypoxic conditions. Water Resources, 43(1), 177-183. 10.1134/S0097807816120046

Dolomatov, S. I., Gozhenko, A. I., Zhukov, V. A., Dolomatova, E. A., & Nasibullin, B. A. (2005). Characteristics of the kidney functional state after a single dose of thyroxine in white rats. Patologicheskaia Fiziologiia i Eksperimental'Naia Terapiia, (1), 16-19. Retrieved from www.scopus.com

Dolomatov, S. I., Hozhenko, A. I., Zhukov, V. A., & Dolomatova, O. O. (2003). Effect of ultraviolet irradiation of human blood on serum concentration of triiodothyronine and thyroxine. [Vplyv ul'trafioletovoho oprominennia krovi liudyny na kontsentratsiiu tryiodtyroninu ta tyroksynu v plazmi.] Fiziolohichnyi Zhurnal (Kiev, Ukraine : 1994), 49(4), 80-83. Retrieved from www.scopus.com

Dolomatov, S. I., Kubyshkin, A. V., Zukow, W. A., Kutia, S. A., Cieslicka, M., Muszkieta, R., & Napierala, M. (2014). Prospects for the replenishment of a feed protein deficit in aquaculture. Russian Journal of Marine Biology, 40(4), 233-240. 10.1134/S106307401404004X

Dolomatov, S. I., Shekk, P. V., Zukow, W., & Kryukova, M. I. (2011). Features of nitrogen metabolism in fishes. Reviews in Fish Biology and Fisheries, 21(4), 733-737. 10.1007/s11160-011-9212-z

Dolomatov, S. I., & Zhukov, V. A. (2008). Effect of exogenous thyroxin on renal ion-regulating and acid-secreting functions in white rats. Aviakosmicheskaya i Ekologicheskaya Meditsina, 42(1), 62-63. Retrieved from www.scopus.com

Dolomatov, S. I., Zukow, W., Atmazhov, I. D., Muszkieta, R., & Skaliy, A. (2012). The use of hormones indicators in human saliva in diagnosing parodontitis in pregnant women. Indian Journal of Human Genetics, 18(3), 305-309. 10.4103/0971-6866.107982

Dolomatov, S. I., Zukow, W., Novikov, N. Y., Muszkieta, R., Bulatowicz, I., Dzierzanowski, M., . . . Strojek, K. (2012). The regulation of osmotic and ionic balance in fish reproduction and in the early stages of ontogeny. Russian Journal of Marine Biology, 38(5), 365-374. 10.1134/S1063074012050057

Dragomiretskaya, N., Izha, A., Kalinichenko, N., Szark-Eckardt, M., Klimczyk, M., Cieślicka, M., . . . Zukow, W. (2015). Use of antiviral therapy in patients with chronic hepatitis C. Open Medicine (Poland), 10(1), 209-215. 10.1515/med-2015-0032

Dzierzanowski, M., Dzierzanowski, M., Maćkowiak, P., Słomko, W., Radzimińska, A., Kaźmierczak, U., . . . Zukow, W. (2013). The influence of active exercise in low positions on the functional condition of the lumbar-sacral segment in patients with discopathy. Advances in Clinical and Experimental Medicine, 22(3), 421-430. Retrieved from www.scopus.com

Dzierzanowski, M., Dzierzanowski, M., Wrzecion, K., Słomko, W., Radzimińska, A., Kaźmierczak, U., . . . Zukow, W. (2013). Discopathy of the lumbar-sacral segment and its influence on sexual dysfunction. Advances in Clinical and Experimental Medicine, 22(1), 93-100. Retrieved from www.scopus.com

Eksterowicz, J., Napierała, M., & Zukow, W. (2016). How the kenyan runner's body structure affects sports results. Human Movement, 17(1), 8-14. 10.1515/humo-2016-0002

Gorsha, O. V., Aplevich, V. M., & Zukow, W. (2017). Efficiency of kinesiotaping application in the complex rehabilitation of children with idiopathic scoliosis. Journal of Physical Education and Sport, 17(3), 1154-1157. 10.7752/jpes.2017.03177

Ivashchenko, O., Khudolii, O., Iermakov, S., Lochbaum, M., Cieślicka, M., Zukow, W., . . . Yermakova, T. (2017). Methodological approaches to pedagogical control of the functional and motor fitness of the girls from 7-9 grades. Journal of Physical Education and Sport, 17(1), 254-261. 10.7752/jpes.2017.01038

Ivashchenko, O., Khudolii, O., Iermakov, S., Lochbaum, M. R., Cieslicka, M., Zukow, W., . . . Yermakova, T. (2016). Intra-group factorial model as the basis of pedagogical control over motor and functional fitness dynamic of 14-16 years old girls. Journal of Physical Education and Sport, 16(4), 1190-1201. 10.7752/jpes.2016.04190

Kozina, Z., Sobko, I., Yermakova, T., Cieslicka, M., Zukow, W., Chia, M., . . . Korobeinik, V. (2016). Psycho-physiological characteristics of female basketball players with hearing problems as the basis for the technical tactic training methodic in world level teams. Journal of Physical Education and Sport, 16(4), 1348-1359. 10.7752/jpes.2016.04213

Kul'chyns'kyi, A. B., Kyjenko, V. M., Zukow, W., & Popovych, I. L. (2017). Causal neuro-immune relationships at patients with chronic pyelonephritis and cholecystitis. correlations between parameters EEG, HRV and white blood cell count. Open Medicine (Poland), 12(1), 201-213. 10.1515/med-2017-0030

Novikov, N., Dolomatov, S., Zukow, W., Volyanskaya, A., Napierala, M., Hagner-Derengowska, M., . . . Skaliy, A. (2012). Pathogenetic mechanisms of posttraumatic fibrosis of the uterus of white rats. Central European Journal of Medicine, 7(4), 503-510. 10.2478/s11536-011-0168-0

Podrigalo, L., Iermakov, S., Rovnaya, O., Zukow, W., & Nosko, M. (2016). Peculiar features between the studied indicators of the dynamic and interconnections of mental workability of students. Journal of Physical Education and Sport, 16(4), 1211-1216. 10.7752/jpes.2016.04193

Sataieva, T., & Zukow, W. (2014). The respective effects of ethyl alcohol and grape polyphenols upon the morphological index of rat kidneys. Central European Journal of Medicine, 9(6), 866-869. 10.2478/s11536-013-0326-7

Babelyuk, Ye.V., Dubkova, G. I., Korolyshyn, T. A., Holubinka, S. M., Dobrovol’S’Kyi, Y. G., Zukow, W., . . . Popovych, I. L. (2017). Operator of kyokushin karate via kates increases synaptic efficacy in the rat hippocampus, decreases C3-θ-rhythm SPD and HRV vagal markers, increases virtual chakras energy in healthy humans as well as luminosity of distilled water in vitro. preliminary communication. Journal of Physical Education and Sport, 17(1), 383-393. 10.7752/jpes.2017.01057

Zadnipryany, I. V., Sataieva, T. P., Tretiakova, O. S., Kubyshkin, A. V., & Zukow, W. (2017). Grape polyphenols concentrate demonstrates cardioprotection in terms of hypoxic myocardial injury. Russian Open Medical Journal, 6(4)10.15275/rusomj.2017.0404

Zadnipryany, I. V., Tretiakova, O. S., Sataieva, T. P., & Zukow, W. (2017). Experimental review of cobalt induced cardiomyopathy. Russian Open Medical Journal, 6(1)10.15275/rusomj.2017.0103

Zubkova, O., Semenova, V., Samosiuk, I., Zukow, W., Vaslovich, V., & Samosiuk, N. (2014). Analysis of ultrastructural synaptic apparatus in parietal neurocortical and midbrain neurons in animals with experimental mild craniocerebral injury prior to and following magneto-laser therapy. Central European Journal of Medicine, 9(5), 714-721. 10.2478/s11536-013-0338-3

Zukow, W., Kalisz, Z., Muszkieta, R., & Napierala, M. (2011). Acupuncture for rheumatoid arthritis: A randomized, sham-controlled clinical trial. Journal of Acupuncture and Tuina Science, 9(3), 168-172. 10.1007/s11726-011-0502-8