HISTORY. Establish a history of bone-related pain. Determine if the patient has experienced constant back pain that intensifies with exercise, other aching bone pain, or arthritic-type joint pain. Ask if the patient has experienced any numbness, prickling, or tingling of the extremities (peripheral paresthesia); confusion; fatigue; or weakness. Determine if the patient has experienced weight loss, nausea, vomiting, polyuria, or polydipsia. Ask if the patient has been exposed to radiation on the job or has undergone radiation therapy. Establish a history of body height reduction; vertebral collapse may cause a reduction in height of up to 5 inches or more. Find out if the patient has relatives who have been diagnosed with multiple myeloma.

PHYSICAL EXAMINATION. Examine for signs of pathological compression fractures of the vertebral column or long bones. Inspect for joint swelling. Note any joint, long bone, or flat bone tenderness. Note cranial nerve palsies, which may be caused by tumor occlusion of vascular flow. Radiculopathies develop from nerve root compression where there is bone infiltration. Carpal tunnel syndrome is common. In advanced cases, noticeable thoracic deformities may be observable. With patients already on chemotherapy for multiple myeloma, note any signs of infection, such as fever and malaise.

PSYCHOSOCIAL. The psychosocial needs of the patient with multiple myeloma may be complex. The patient faces coping with a chronic, painful, and potentially fatal disease that is treated with potentially painful and uncomfortable regimens. Be sensitive to the enormous psychological strain placed on the patient. Consider the effects of the disease on the patient's job status, personal relationships, financial resources, and body image. Assess the patient's support network.

Diagnostic Highlights


Normal Result

Abnormality with Condition


Serum protein

Presence of

Presence of abnormally

Identifies abnormal proteins

electrophoresis; urine

normal Immuno

low levels of

produced by cancerous plasma

protein electrophoresis

globulins: IgM,


cells as compared with product

Back Pain Revealed

Back Pain Revealed

Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.

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