Increased Patient-Reported Pain Severity Associated With Decreased HRQOL in Multiple Myeloma


A real-world study using a voluntary questionnaire found an association between increased pain severity and decreased health-related quality of life for patients with multiple myeloma.

A higher patient-reported pain severity was associated with a poorer health-related quality of life (HRQOL) for patients with multiple myeloma, according to results from a real-world study published in Cancer Reports.

Specifically, an increase in pain severity from “no” to “severe” pain was associated with a statistically significant decrease in overall HRQOL for patients with multiple myeloma (mean score, 70.2 to 33.3; P <.001).

“We observed that a higher level of patient self-reported pain severity was related to poorer HRQOL,” the investigators wrote. “The relationships identified here between patient self-reported pain severity and HRQOL support the clinical relevance of directly asking patients to self-rate their pain severity.”

Patients with symptomatic multiple myeloma aged 18 years or older who received first-line or second- and subsequent-lines of therapy voluntarily completed questionnaires that asked them to rate the severity of their pain. The survey asked, “Please tick the box that best describes the level of pain that you are currently experiencing.” Response options included “no pain,” “mild pain,” “moderate pain,” and “severe pain.”

Responses to the single pain severity question were aligned with the EuroQol 5-dimension 5-level (EQ-5D-5L) questionnaire, and responses to the European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ) were also aligned with this question.

A total of 330 patients with multiple myeloma were included in this research from November 2017 to February 2018. The majority of patients were from Germany (80.9%), female (62.7%), and retired at time of the survey (65.5%). Median age was 70 years. Median time between disease diagnosis and survey was 0.96 years.

Bone pain was reported by 87.6% of patients and 76.4% of patients reported non–site specific bone aches or pain. Vertebral pain was also reported by most patients (72.1%), and other sites of bone pain were in the hip (56.1%) and chest/ribs (33.3%).

At the time of survey, 22.0% of patients self-reported having no pain, 48.8% had mild pain, 24.6% had moderate pain, and 4.6% had severe pain. Most patients who reported pain of any severity at this time experienced bone pain in the 7 days before survey administration.

Investigators reported changes in EORTC QLQ-C30 mean scores in the physical (82.7 to 35.11), social (81.1 to 44.4), emotional (78.1 to 48.3), and role functioning domains (79.5 to 38.9) as pain severity increased from no pain to severe pain (P <.001).

The investigators noted that data taken from small sample sizes, such as findings from the severe pain group, should be interpreted with caution. Future research featuring larger samples is needed to confirm the findings from this real-world study.

“A simple and direct approach for understanding pain severity may simplify and expedite HRQOL assessment and may also guide physicians in choosing treatment options to reduce and alleviate pain and improve HRQOL in patients with multiple myeloma,” the investigators concluded.


Ludwig H, Bailey AL, Marongiu A, et al. Patient-reported pain severity and health-related quality of life in patients with multiple myeloma in real world clinical practice. Cancer Rep (Hoboken). 2022;5(1):e1429. doi:10.1002/cnr2.1429

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