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Published on July 9, 2021
Doctor Shares Myelofibrosis Pain Management Options
What are some pharmacological and non-pharmacological options for managing pain while living with myelofibrosis? In this segment, Angela Fleischman, MD, PhD, from UC Irvine Health, explains drug options for pain symptoms and speaks of an ongoing study into the benefits of yoga for patients as well as her own study looking at the potential benefits of a Mediterranean diet.
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Transcript | Pain Management Options for Myelofibrosis
How Can Myelofibrosis Pain Manifest Itself? What Are the Pharmacological Pain Management Options?
Dr. Fleischman: Pain is a big issue in myelofibrosis, and although we have some interventions that can be helpful, I think we have a long ways to go to fully address pain in myelofibrosis. First of all, it's important to note that pain can be from multiple different sources in myelofibrosis. For example, an enlarged spleen. So, an enlarged spleen can cause abdominal pain, abdominal fullness, and some constipation, causing a lot of discomfort. Other things that can cause pain in myelofibrosis is inflammation. Inflammation is high in myelofibrosis, and that can make people not feel very well and cause joint aches, muscle aches, just a feeling of not really a well-being feeling. Also, patients can experience bone pain because myelofibrosis is a disease of the bone marrow. When the bone marrow is really trying hard to make cells, it can cause some bone aches or bone pain, so it's important to note where the pain is coming from.
It's also important for myeloproliferative neoplasm patients to understand that it's possible that not all of their symptoms are directly related to their MPN. Sometimes patients tend to blame all of their problems on their MPN just because they have an MPN, and not really delve into whether totally separate issues could be causing some of their symptoms or their pain. But to get back to the root of the problem of MPN-associated pain, if the spleen or inflammation is causing the pain, JAK inhibitors are actually quite helpful for reducing spleen size and reducing inflammation.
What Are Some of the Non-Pharmacological Pain Management Options?
As examples of non-pharmacological interventions that have been investigated in MPNs, includes a yoga study, also a mindfulness study, and we have been investigating the role of diet in MPN symptoms. For our studies, one needs to really start slowly and really go step by step in order to fully investigate the impact of specific interventions in MPNs. Initially what we did was a small pilot study with the purpose of testing whether MPN patients can follow a Mediterranean diet, which is intrinsically low in inflammatory foods and high in antioxidant foods. If we give them a dietary counseling and curriculum, are they able to change their diet more towards a Mediterranean diet? In our first pilot study, we did establish that MPN patients are able to follow a Mediterranean diet if we give them counseling.
Next, we're moving on now to testing whether a fully Zoom-based and online-based dietary intervention is feasible in MPN patients. That study is ongoing. While in our studies, we track patient symptoms, because the numbers of patients that we enroll in these studies are small, they're not what we say, “powered,” to definitively detect whether a diet can reduce symptoms in MPN patients. Next, we will move on to much larger studies with many more MPN patients in order to definitively determine whether diet can reduce symptoms. Another thing that we'd like to test in these diet studies is whether we can see a reduction in inflammatory biomarkers in MPN patients, but those results are forthcoming.