Understanding the Impact of Pain on Opioid Use Disorder, Alcohol Abuse, Depression, Anxiety, and Suicidality Among Multiple Myeloma Patients; A Pooled-Database Analysis from the United States
Authors: Gadhiya Dhruvkumar , Singh Gurjot , Goswami Kanishka , Shergill Harkaran , Singla Rahul , Ramphul Kamleshun , Ramphul Yogeshwaree , Verma Renuka , Sakthivel Hemamalini , Chennapragada Suma Sri 
Published: December 2024

Introduction: Multiple myeloma (MM), a plasma cell dyscrasia, causes bony resorption and bone pain by inducing osteoclast activity. The presence of neoplastic pain among cancer patients can impair their quality of life and lead to various psychological stresses. At present, as there are no recent studies on the prevalence of neoplastic pain among MM patients and subsequent pain-induced complications, we conducted a retrospective study through an extensive inpatient database from the United States.

Methods: Data of adult patients, ages 18 years and older, diagnosed with multiple myeloma in relapse was extracted through the 2016 to 2021 National Inpatient Sample(NIS). The NIS is a set of de-identified hospitalization records that covers over 97% of the annual data and is produced as part of the Healthcare Cost and Utilization Project (HCUP). The presence of pain due to neoplasm was identified, and we compared the baseline demographics and characteristics of patients with vs. without pain. We further explored the odds of opioid use disorder, alcohol abuse, depression, anxiety, and suicidality between the two groups through logistic regression models, adjusting for clinically relevant confounders.

Results: An estimated 50915 multiple myeloma patients matched our selection. This included 8935(17.5%) patients with pain, who were younger, with a mean age of 61.81 years (vs. 65.92 years, p&lt;0.01). Both groups mainly consisted of males (57.2% among those with pain vs. 56.2% among those without pain, p=0.028), racially classified as Whites(61.0% among those with pain vs. 62.6% among those without pain, p&lt;0.01), covered by Medicare (53.5% among those with pain vs. 61.1% among those without pain, p&lt;0.01), and treated in urban teaching hospitals( 93.2% among those with pain vs. 87.4% among those without pain, p&lt;0.01). The group of patients with pain was more likely to report opioid use disorder (10.7% vs. 2.0%, aOR 5.557, 95% CI 5.024-6.148, p&lt;0.01) while having lower odds of alcohol abuse(0.6% vs. 0.7%, aOR 0.648, 95% CI 0.462-0.909, p=0.012). We further noted that patients with pain also expressed higher odds of depression (18.3% vs. 12.9%, aOR 1.444, 95% CI 1.353-1.540, p&lt;0.01) and anxiety (24.7% vs. 14.6%, aOR 1.844, 95% CI 1.737-1.956, p&lt;0.01). However, no differences were observed for suicidality among multiple myeloma patients with vs. without pain (0.2% vs. 0.2%, aOR 0.951, 95% CI 0.579-1.563,p=0.843).

Conclusion: Our study confirms that neoplastic pain was an important complication among MM patients and involved an overall younger group. Furthermore, neoplastic pain was linked with higher odds of opioid use disorder, depression, and anxiety. Such findings raise several concerns, and it is vital to advocate for additional changes in treatments and follow-ups to diagnose any early signs of depression or anxiety and enquire about the use of opioids in a non-judgemental manner while providing them with adequate alternatives for their pain. More studies are also encouraged to analyze and identify any disparities affecting pain and mitigate pain-related complications.