We often see people with persistent musculoskeletal pain, fatigue, or recurrent injuries. Usually, these come from overuse or minor trauma. But occasionally symptoms don’t follow the expected pattern, or fail to settle with standard treatment — and then it’s important to consider less common causes. One is multiple myeloma. Though rare, it can present in a sports medicine clinic, particularly in older people with persistent or unexplained pain. So, what is multiple myeloma, how does it present, and when should we consider screening?
What is multiple myeloma?
Multiple myeloma is a blood cancer that starts in plasma cells in the bone marrow. These abnormal cells multiply, crowding out healthy blood cells and producing abnormal proteins that damage bones and organs. It usually occurs in people over 60, though it can appear earlier. Because it develops gradually and may cause few symptoms at first, the diagnosis is often delayed.
A key feature is its effect on the skeleton — it weakens bone, causing pain, fractures, or collapse. That’s why it matters in sports medicine, where we may see people with unexplained bone pain or fractures. Knowing when to consider a multiple myeloma screen helps ensure the diagnosis isn’t missed.
Symptoms: the musculoskeletal red flags
Bone pain is one of the commonest early symptoms, often in the lower back, pelvis, ribs, or hips. About half of the people with myeloma present with back pain. Crucially, this pain is often non-mechanical — dull and constant, present at rest or at night — unlike typical mechanical pain, which worsens with movement and eases with rest. Some people present with a spinal compression fracture.
Other red flags include pain that doesn’t respond to usual treatment (no improvement with physiotherapy or anti-inflammatories), and spontaneous fractures — particularly a crush vertebral fracture without significant trauma, which is especially concerning in a younger person.
Beyond bone, watch for fatigue (often from anaemia), feeling generally unwell with vague weight loss or low-grade fever, and recurrent infections (from a weakened immune system). Sometimes people present with features of a high calcium level — confusion, constipation, nausea, or abdominal pain — which happens when the disease is actively breaking down bone.
From a musculoskeletal viewpoint, these red flags should raise concern and may warrant a multiple myeloma screen.
The myeloma blood screen
Screening for myeloma isn’t routine in a musculoskeletal setting, but it becomes important when symptoms are persistent, atypical, or unexplained. The aim isn’t to make a definitive diagnosis — it’s to identify who needs further investigation.
The first step is a careful history: does the pain occur at rest or at night, does it respond to load modification, and is there any unexplained injury? We also ask about fatigue, weight loss, and frequent infections.
If concern remains, blood tests guide the next step:
- Full blood count (FBC) — to detect anaemia, which is common in myeloma.
- ESR or CRP — a raised ESR is often present.
- Serum calcium and kidney function — myeloma can raise calcium and damage the kidneys.
- Serum protein electrophoresis and serum free light chain assay should be ordered together, as this combination detects about 98% of multiple myeloma cases.
If any are abnormal, referral to a haematologist is warranted for a bone marrow biopsy and advanced imaging.
The role of imaging in a multiple myeloma screen
Imaging is often part of a musculoskeletal assessment and can give vital clues.
Plain X-rays may show small “punched-out” holes in the bone (lytic lesions), most often in the spine, pelvis, and skull. MRI is more sensitive, detecting early marrow involvement and compression fractures. If the MRI shows bone abnormalities without soft-tissue damage in someone with unexplained symptoms, myeloma should be considered. MRI can also show red marrow reconversion, which sometimes requires investigation to ensure myeloma isn’t the cause. Haematology teams may add CT or PET to assess the extent of disease.
Frequently asked questions about a multiple myeloma screen
Which blood tests detect multiple myeloma?
The key tests are serum protein electrophoresis and the serum free light chain assay, ordered together — they detect around 98% of cases. We also look for anaemia (FBC), high calcium levels, elevated inflammatory markers, and impaired kidney function.
What musculoskeletal symptoms are suspicious for myeloma?
Back, hip, or pelvic pain that doesn’t settle with treatment, is worse at night, and is unchanged by activity. A crush vertebral fracture without significant trauma — particularly in a younger person — is especially suspicious.
Is multiple myeloma the most likely cause of my back pain?
Almost certainly not — the vast majority of back and bone pain is mechanical and benign. A myeloma screen is reserved for pain with red flags (non-mechanical, night pain, unresponsive to treatment, unexplained fracture). It’s about not missing a rare but serious cause, not about expecting it.
How is myeloma confirmed after an abnormal screen?
A haematologist confirms it with a bone marrow biopsy and detailed imaging. The screen simply flags who needs that referral — it doesn’t diagnose myeloma on its own.
Why does early detection matter?
Because catching myeloma early — before major bone destruction or kidney damage — substantially improves outcomes. That’s the whole point of screening the right people at the right time.
Final word from Sport Doctor London about a multiple myeloma screen
Multiple myeloma is a rare cause of musculoskeletal pain, but an important one not to miss. When symptoms persist, are non-mechanical, and don’t respond to standard care, consider a screening for multiple myeloma. Early detection dramatically improves outcomes and reduces the risk of serious complications such as fractures and kidney damage.
If you have unexplained or non-mechanical bone pain, Dr Masci can assess you in London and arrange the right tests. Contact the team here or call +44 (0) 203 488 0350.
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