The pain management team formulated a plan, together with the patient. The team explained the next steps, which would include some further investigations, including blood tests and an MRI scan of his spine, aiming to exclude serious pathology.
An MRI scan of his spine was requested because of the new thoracic pain, in addition to the other red flag features of weight loss and night pain. This was undertaken on an urgent basis and demonstrated a compression fracture of the T8 vertebra and a lytic lesion at T12. His initial blood investigations also revealed hypercalcaemia and renal impairment.
The patient was contacted immediately, and the possible diagnosis of a malignancy was explained to him. He was urgently referred to the local haematology team, who requested further investigations and confirmed the diagnosis of multiple myeloma. The patient went on to have chemotherapy, followed by a stem cell transplant and 12 months later is currently doing well.
