Unexplained Bone Pain? Why Multiple Myeloma Occurs and What to Do Next

Unexplained bone pain can be frustrating—and sometimes frightening. Most of the time, bone pain is caused by common issues like arthritis, injury, or overuse. But in rare cases, it can be a sign of a serious blood cancer called multiple myeloma.

Understanding what multiple myeloma is, why it occurs, and what medical steps to take can help you act early and appropriately—without unnecessary panic.

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What Is Multiple Myeloma?

Multiple myeloma is a type of blood cancer that starts in plasma cells. Plasma cells are a kind of white blood cell found in your bone marrow. Their normal job is to help your body fight infection by producing antibodies.

In multiple myeloma:

• Abnormal plasma cells grow out of control.
• These cancerous cells crowd out healthy blood-forming cells.
• They produce abnormal proteins that can damage organs.
• They can weaken bones from the inside.

Multiple myeloma is considered uncommon, but it is one of the more common blood cancers in adults. It occurs most often in people over age 60, though it can happen earlier.

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Why Does Multiple Myeloma Occur?

The exact cause of multiple myeloma is not fully understood. However, research from leading cancer institutions has identified several contributing factors.

1. Genetic Changes in Plasma Cells

Multiple myeloma develops after DNA mutations occur in plasma cells. These mutations:

• Cause cells to multiply uncontrollably
• Prevent normal cell death
• Lead to production of abnormal proteins

These mutations are usually not inherited. They develop over time.

2. Age

Risk increases significantly after age 60. The disease is rare in people under 40.

3. Precursor Conditions

Many patients with multiple myeloma first develop a condition called:

• MGUS (Monoclonal Gammopathy of Undetermined Significance)
• Smoldering multiple myeloma

These conditions are not cancer but can slowly progress into active multiple myeloma in some people.

4. Other Risk Factors

Research suggests higher risk in individuals with:

• A family history of multiple myeloma
• Obesity
• Male sex
• Certain racial backgrounds (higher incidence in Black individuals)
• Exposure to certain chemicals or radiation (less common)

Importantly, most people with risk factors do not develop multiple myeloma.

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Why Does Multiple Myeloma Cause Bone Pain?

Bone pain is one of the most common symptoms of multiple myeloma.

Here's why:

• Myeloma cells stimulate cells that break down bone (osteoclasts).
• At the same time, they suppress cells that build new bone.
• This creates areas of bone weakness or "holes" called lytic lesions.

These weakened bones may:

• Cause persistent deep pain
• Fracture more easily
• Collapse (especially in the spine)

Common pain locations include:

• Lower back
• Ribs
• Hips
• Shoulders

Unlike muscle pain, bone pain from multiple myeloma is often:

• Constant
• Worse at night
• Not clearly linked to movement or injury

However, many other conditions can cause similar symptoms, so bone pain alone does not mean cancer.

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Other Symptoms of Multiple Myeloma

Doctors often use the acronym CRAB to remember common signs:

• C – Calcium elevation (high blood calcium)
  May cause nausea, constipation, confusion, or thirst.

• R – Renal (kidney) problems
  Abnormal proteins can damage kidneys.

• A – Anemia
  Low red blood cells can cause fatigue and weakness.

• B – Bone lesions or fractures

Other possible symptoms include:

• Frequent infections
• Unexplained weight loss
• Numbness or tingling (if nerves are affected)

Many people are diagnosed after routine blood tests show abnormalities before symptoms become severe.

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When Should You Be Concerned About Bone Pain?

Seek medical evaluation if you have:

• Persistent bone pain lasting more than a few weeks
• Pain without injury
• Pain that wakes you at night
• Recurrent fractures
• Fatigue with unexplained anemia
• Kidney problems without a clear cause

Do not ignore severe or worsening pain.

However, remember: most bone pain is not multiple myeloma. The key is proper evaluation.

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Medical Next Steps: What Your Doctor May Do

If multiple myeloma is suspected, your doctor will perform a structured evaluation.

1. Medical History and Physical Exam

Your doctor will ask about:

• Duration and pattern of pain
• Fatigue
• Infections
• Weight changes
• Family history

2. Blood Tests

These may include:

• Complete blood count (CBC)
• Calcium levels
• Kidney function tests
• Serum protein electrophoresis (SPEP)
• Free light chain assay

These tests look for abnormal proteins and blood changes typical of multiple myeloma.

3. Urine Tests

A 24-hour urine test may detect abnormal proteins called Bence Jones proteins.

4. Imaging Studies

To check for bone damage:

• X-rays
• MRI
• CT scan
• PET scan (in some cases)

MRI is particularly helpful for detecting early bone marrow involvement.

5. Bone Marrow Biopsy

If blood or imaging tests suggest multiple myeloma, a bone marrow biopsy confirms the diagnosis.

This test:

• Examines plasma cell percentage
• Identifies genetic abnormalities
• Helps determine disease stage

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How Serious Is Multiple Myeloma?

Multiple myeloma is a serious condition. However, treatments have improved dramatically over the past two decades.

Current treatment options may include:

• Targeted therapy
• Immunotherapy
• Chemotherapy
• Steroids
• Stem cell transplant (in eligible patients)
• Radiation (for bone pain control)

Many patients now live significantly longer than in the past. Some achieve long-term remission.

Early detection improves outcomes.

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If You're Unsure: Consider a Symptom Check

If you are experiencing unexplained bone pain or related symptoms and want to better understand whether they align with Multiple Myeloma (MM) warning signs, a free AI-powered symptom checker can provide immediate guidance before your doctor's appointment.

This type of tool can help you:

• Understand whether your symptoms match common patterns
• Decide whether to seek urgent care
• Prepare questions for your doctor

It is not a replacement for medical care—but it can be a helpful first step.

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Practical Advice If You're Experiencing Bone Pain

While waiting for medical evaluation:

• Avoid heavy lifting if bones feel fragile.
• Stay hydrated.
• Keep a symptom diary.
• Note any new fatigue, infections, or neurological symptoms.
• Do not self-diagnose based on internet searches alone.

If you experience:

• Sudden severe back pain
• Weakness in your legs
• Loss of bladder or bowel control

Seek emergency care immediately, as these can indicate spinal cord compression.

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The Bottom Line

Unexplained bone pain deserves attention—but not panic.

Multiple myeloma is a rare but serious blood cancer that can weaken bones and affect blood and kidney function. It occurs due to genetic mutations in plasma cells, usually later in life, and often develops from precursor conditions.

If symptoms are persistent or concerning:

• Get evaluated with blood tests and imaging.
• Do not delay if pain worsens or new symptoms develop.
• Ask specifically whether testing for multiple myeloma is appropriate.

Most importantly, speak to a doctor promptly about any symptoms that could be life-threatening or serious. Early evaluation can provide reassurance—or allow treatment to begin at the most effective time.

Your health is not something to ignore. But it is also not something to fear without facts. Get informed, get checked, and move forward with clarity.