Bortezomib-induced peripheral neuropathy in patients with multiple myeloma: pain syndrome and psychopathological aspects

   Background. One of the most common causes of peripheral neuropathy in multiple myeloma patients is bortezomib‑induced peripheral neuropathy (bIpN), which is clinically characterized by paresthesia, a burning sensation, numbness, and primarily pain in the limbs. This pain syndrome is often associated with the development of anxiety and depression.

   Aim. To study the pain syndrome associated with BIPN and determine the relationship between mental disorders and pain descriptors in patients with multiple myeloma at the completion stage of induction therapy and after autologous hematopoietic stem cell transplantation (auto‑HSCT).

   Materials and methods. From January 2023 to April 2024 a prospective study was conducted to examine pain and its relationship with psychopathological manifestations. The study included 48 patients (38 women and 10 men, median age 54 years) with multiple myeloma and diagnosed bIpN. pain syndrome and psychometric indicators were assessed using various validated algometric and psychometric techniques during hospitalization before auto‑HSCT and on day 100 after transplantation. Electroneuromyography was performed at the same time for an objective assessment of the studied parameters.

   Results. BIPN was diagnosed in 32 % of patients. pain intensity ranged from minimal to unbearable, With higher BIPN severity correlating with more vivid and diverse descriptions of the pain syndrome. pain localized in the fingers and toes predominated in 58 % of patients. The use of the pain detect questionnaire and the visual Analog Scale allowed for a detailed evaluation of changes in pain syndrome, revealing a statistically significant reduction in pain intensity 100 days after auto‑HSCT (p < 0.05). A control electroneuromyography conducted 100 days after auto‑HSCT confirmed
partial or complete restoration of nerve fibers functional state. Based on the beck Anxiety and depression Inventory questionnaires completed by patients with pronounced pain syndrome, anxiety symptoms were identified in 6 cases (18 %), and depressive states in 8 cases (24 %). A study of patients’ psycho‑emotional states 100 days after auto‑HSCT showed a reduction in the frequency and severity of depressive states. However, unlike depression, anxiety persisted in the same patients.

   Conclusion. The conducted study, which testifies to the presence and persistence of psychoemotional disorders in a number of patients, indicates the need for a comprehensive approach to treatment, including not only pain therapy, but also psychoemotional support.

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