Uncle Wu is 65 years old this year. Although he has already entered old age, his body has always been very tough, but in the past six months, he has always felt back pain, especially the waist. At first, Uncle Wu just thought that he was getting old and his waist was useless, so he went to a massage shop recommended by a friend for a massage. However, although I go for a waist massage almost every week, not only did the low back pain not relieve, but it was so severe that I couldn’t even walk.
Uncle Wu, who felt bad, rushed to the orthopaedic department of the hospital for treatment. After a CT examination, the report showed “multiple bone destructions such as thoracolumbar spine and ribs, pathological fractures of lumbar vertebrae 3 and 4”. Increased protein, renal insufficiency and anemia, the doctor suspected multiple myeloma, so Uncle Wu was transferred to the hematology department for further treatment.
This made Uncle Wu dizzy. Wasn’t he going to see an orthopaedic surgeon for low back pain? Why did you suddenly transfer to the hematology department and be hospitalized?
First, multiple myeloma is more common in middle-aged and elderly people
Multiple myeloma is A class of plasma cell malignancies in which clonal plasma cells in the bone marrow proliferate abnormally and secrete monoclonal immunoglobulin or fragments thereof (M protein), resulting in associated organ or tissue damage. In my country, most of the patients with multiple myeloma are middle-aged and elderly people, which are mainly manifested as substantive damage involving the skeletal system, blood system, immune system, kidney and other systems, resulting in death of patients.
The disease has complex clinical features, diverse manifestations, insidious onset and lack of specificity, which leads to dysfunction of tissues and organs in multiple systems of the body, which is easy to cause misdiagnosis or missed diagnosis, thus delaying timely treatment. It has been reported in the literature that the misdiagnosis rate of the disease was as high as 65.17% in 2009 and 56.44% in 2013.
Second, the initial symptoms are diverse and easy to be misdiagnosed
The four most important clinical manifestations of multiple myeloma can be summarized as “CRAB”< /strong>, specific manifestations were hypercalcemia, renal insufficiency, anemia, bone pain.
1. Hypercalcemia
99% of the calcium in the human body is stored in the bones. Calcium is released into the blood, causing an increase in blood calcium.
2. Renal insufficiency
Myeloma cells will secrete a large amount of M protein, which will cause damage to the kidneys. Laboratory tests can show that urine protein is positive, albumin Decreased levels or increased creatinine.
3. Anemia
Myeloma cells proliferate malignantly in the bone marrow. Uncontrolled, it will inhibit the proliferation of normal hematopoietic stem cells, resulting in a decrease in the number of red blood cells , causing the patient to develop anemia.
4. Bone pain
Myeloma cells secrete some cytokines, which can dissolve bones, causing patients to suffer from fractures, loose, fractured, pathological fractures, etc.
In addition to the above four typical symptoms, the initial symptoms of multiple myeloma patients are also different. disease, or pathological fractures, the root cause of the problem cannot be found in the orthopaedic department and the treatment time is missed; some patients were found to have anemia, proteinuria, abnormal renal function and other problems during the physical examination, strong>A visit to a cardiology or nephrologist doesn’t really solve the problem.
According to statistics, almost 60% of multiple myeloma in my country will be misdiagnosed in clinic, and nearly 1/3 of the inpatients have been treated in other departments, showing multiple myeloma. Myeloma has a high misdiagnosis rate and is the “chameleon” of malignant hematological diseases.
However, although the clinical manifestations of multiple myeloma are diverse, the laboratory diagnosis of typical multiple myeloma is not difficult. If the protein increases, M protein is detected in serum immunofixation electrophoresis, and the abnormal plasma cells increase by more than 10% in bone marrow smear staining, the basic diagnosis can be made.
This also reminds the public that they should develop a good habit of regular physical examinations, and routine examinations such as blood and urine routines can often catch the “clues” of the disease.
Three, long-term low back pain, but also pay attention to the following causes
Low back pain is one of the common diseases , about 75% of people will have this symptom at a certain age, especially when they get older. At present, the cause of this disease is not very clear, but there are many reasons for low back pain.
1. Problems of the lumbar spine
With the increase of age, many patients develop lumbar disc herniation due to long-term chronic strain and external force injury, or Lumbar spinal stenosis, etc. The changes in work and living habits of the younger generation have made the low back pain caused by these diseases tend to be younger.
2. Muscle Problems
Excessive mobility of an unstable spine can cause pain, partly due to the reflex inhibition or activity of the muscles produced by the pain Insufficient, causing different degrees of muscle disuse atrophy, and further lead to a vicious cycle of pain-muscle spasm-muscle atrophy-pain; Extensor atrophy is caused by the imbalance of the nutrient function of the lateral branch.
3. Herpes zoster
Herpes zoster neuralgia is one of the common complications of herpes zoster. Chronic pathological pain with persistent damage to peripheral neurons due to inflammation or immune response.
Because the herpes zoster virus is neurotropic, it is often hidden in the dorsal root of the spinal nerve, and when it is stimulated, it spreads along the dorsal root of the nerve. It is easy to be confused with low back pain.
4. Kidney disease
Kidney problems may indeed cause low back pain, such as kidney stones. Obvious low back pain, often sudden back pain during activities, severe pain and profuse sweating, and low back pain caused by kidney stones is often accompanied by other symptoms such as red color of urine.
Some young people have low back pain for no reason, accompanied by symptoms such as fatigue, oliguria, urgency, and frequent urination, and no abnormality was found in orthopedic examination, which is likely to be kidney disease The early signs of the disease should go to the nephrology or urology department for further examination.
5. Pancreatic and liver disease
The pancreas and liver are located below the thoracic cavity. The lesions of the pancreas and liver can radiate backward and cause low back pain. If low back pain occurs and is accompanied by yellowing of the skin and retina, nausea and vomiting, fatigue, high fever, gray-white stool, brown urine and other symptoms, high vigilance should be exercised. Pancreatic and liver lesions.
When back discomfort such as backache and low back pain occurs, many patients often think that it is tired, and it may be good to rest for a few days When the symptoms are severe, the first thing to do is to go to the orthopedic department. When the orthopedic department can not find any substantive lesions, the treatment is usually based on lumbar muscle strain. Therefore, patients with renal tuberculosis, herpes zoster, cancer, etc. are often missed clinically. The best time for treatment. It can be seen that if there are discomfort symptoms such as backache and low back pain, and no obvious waist lesions are found in the orthopedic examination, you should think of doing a general physical examination to investigate other causes.
References:
References:
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[1] “Unexplained low back pain alert to myeloma”. Dahe Health News. 2022-04-19
[2] “Rehabilitation nursing strategy and effect of conservative treatment of lumbar disc herniation” “. China Practical Medicine. 2021-02-28