Back Pain, Fatigue and Anemia Over 60: Multiple Myeloma Awareness

You're in your late sixties and your back has been sore for a couple of months. You figured it was the garden, or the drive to see the grandkids. But it isn't settling the way back pain usually does, and lately you feel worn out by mid-afternoon. You've also had two chest colds since the summer.

Most back pain in older adults comes from joints, discs and muscles, and it gets better with time and the right exercise. But now and then, a group of symptoms points to something that needs blood work rather than more stretching. Multiple myeloma is one of those things, and it's worth knowing the pattern.

What is multiple myeloma?

Multiple myeloma is a cancer of plasma cells. Plasma cells live in your bone marrow and normally make antibodies that help you fight infection. In myeloma, abnormal plasma cells build up in the marrow. Over time they can weaken bone, crowd out the cells that make healthy blood, and release proteins that can strain the kidneys.

Myeloma Canada describes it as the second most common blood cancer, with about 11 Canadians diagnosed every day. It is much more common in older adults, which is why UK guidance from NICE suggests blood tests for myeloma in people aged 60 and over who have persistent bone pain, particularly back pain, or a fracture that can't be explained.

Because the first symptom is often back or rib pain, people sometimes see a physiotherapist, chiropractor or massage therapist before anyone thinks about their blood.

Warning signs to know

Doctors often use the short form CRAB to remember the main problems myeloma causes: high calcium, renal (kidney) problems, anemia, and bone disease. In everyday terms, watch for:

• Back, rib or hip pain that keeps going, especially if it doesn't change much with position or activity
• A fracture from very little force, like a rib that cracks from a cough or a hug, or a spine fracture after a minor bump
• Tiredness, weakness or shortness of breath that seems out of proportion, sometimes with looking pale (signs of anemia)
• Infections that keep coming back, such as repeated chest infections or pneumonia
• Signs of high calcium: strong thirst, peeing a lot, constipation, nausea, low appetite, feeling drowsy or confused
• Easy bruising or bleeding, like nosebleeds or bleeding gums
• Unexplained weight loss

Any one of these on its own is usually explained by something more common. What matters is the combination, especially in someone over 60 whose back pain isn't behaving like ordinary back pain.

When to call 911 or go to the emergency department

Call 911 or go to the nearest emergency department if you have back pain along with any of these:

• New weakness, numbness or tingling in your legs
• Trouble walking or sudden unsteadiness
• New problems controlling your bladder or bowels, or numbness around your groin or inner thighs
• Sudden, severe back pain after a minor strain, especially if you're also very unwell
• Confusion, severe drowsiness, or stroke-like signs such as weakness on one side or slurred speech

The Canadian Cancer Society notes that spinal cord compression is an emergency in people with myeloma. Fast treatment protects your ability to walk and control your bladder.

When to see your doctor

Book a visit with your family doctor soon (within days, not months) if you are over 60 and have:

• Back or rib pain that has lasted several weeks and isn't easing
• A fracture that happened with little or no force
• Back pain plus ongoing fatigue, repeat infections, thirst, constipation or weight loss

Your doctor can order simple blood and urine tests, such as a complete blood count, calcium and kidney function, and protein tests. If those suggest myeloma, the next step is usually a referral to a hematologist. Tell your doctor exactly how long the pain has lasted and what other symptoms you've noticed, even if they seem unrelated.

Why your physiotherapist asks about this

At Vaughan Physiotherapy Clinic, your first visit includes questions that may seem off topic for a sore back. We ask about your age, past cancers, weight changes, how you sleep, whether you feel unwell in general, and how the pain responds to movement. These are screening questions, and they follow the international red flags framework that physiotherapists use to spot serious spine conditions early.

That framework is clear on a few points that guide us:

• No single question or test rules a serious condition in or out. We look at the whole picture.
• Night pain matters more when you can't get comfortable at all, for example when you need to get up and walk the floor, than when a change of position settles it.
• Not having a history of cancer is not, by itself, a reason to relax.
• Myeloma often affects the mid back (thoracic spine), so it belongs on the list when someone older has a spine fracture.

If your story or exam doesn't fit a normal muscle or joint problem, we stop. We explain why, write a short note to your family doctor, and help you get seen. Treatment can wait until the medical side is checked. We would much rather send you for blood work that comes back normal than miss something important.

What physiotherapy can and can't do

Physiotherapy does not treat myeloma. Diagnosis and cancer treatment are handled by your family doctor and a hematology or oncology team.

Where physio can help is alongside that care, with your medical team's go-ahead. That can include safe ways to stay active, building strength and balance, reducing fall risk, managing fatigue, and learning how to move and lift in ways that protect weakened bones. Hands-on spinal manipulation is generally not appropriate when bones are fragile, so we adapt treatment to fit your situation and your doctor's guidance.

Key takeaways

• Most back pain in older adults is not cancer, but a specific pattern deserves blood work.
• Persistent back or rib pain, a fracture from minor force, fatigue and repeat infections together, especially over age 60, should be checked by your doctor.
• New leg weakness, numbness, or bladder or bowel changes with back pain means call 911.
• Physiotherapists screen for warning signs and refer, then can support recovery with your medical team.

Related reading: You may also find our guides to osteoporosis risk factors, chronic low back pain and mechanical low back pain helpful.

If your back pain isn't following the usual path, our physiotherapists can take a careful history, screen for warning signs, and help you decide on the right next step, whether that's exercise and hands-on care or a call to your doctor.

Call: 905-669-1221

Visit: 398 Steeles Ave W #201, Thornhill, ON

Book online: vaughanphysiotherapy.com

Sources

Canadian Cancer Society. (n.d.). Symptoms of multiple myeloma. https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/signs-and-symptoms

Myeloma Canada. (n.d.). Could it be multiple myeloma? Recognizing and identifying the early symptoms and complications of myeloma. https://myeloma.ca/wp-content/uploads/InfoSheet-EN-CoulditbeMMCRAB.pdf

National Institute for Health and Care Excellence. (2015). Suspected cancer: Recognition and referral (NICE guideline NG12). https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer

Finucane, L. M., Downie, A., Mercer, C., Greenhalgh, S. M., Boissonnault, W. G., Pool-Goudzwaard, A. L., Beneciuk, J. M., Leech, R. L., & Selfe, J. (2020). International framework for red flags for potential serious spinal pathologies. Journal of Orthopaedic & Sports Physical Therapy, 50(7), 350-372. https://doi.org/10.2519/jospt.2020.9971

This article is for general information and isn't medical advice. If you have any of the warning signs above, call 911 or contact your doctor right away.