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Bone pain: benign causes or myeloma? | CION Cancer Clinics
Most bone and joint pain is arthritis, back strain or thin bones, not myeloma. Myeloma becomes more likely when a deep bone ache in the back, ribs or hips is new, constant and worse at night, and comes with anaemia, a high calcium, kidney changes or repeated infections. Simple blood and urine protein tests settle the question. This page explains the patterns, the tests, and what results do and do not rule out. At CION Cancer Clinics, our haematologist reviews abnormal blood reports with you, orders only the tests that answer your question and explains each result plainly.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- Is my bone pain myeloma or arthritis?
- How does arthritis pain differ from myeloma pain?
- What else causes bone pain besides myeloma?
- Which tests tell myeloma apart from arthritis?
- What do families believe about bone pain in older adults?
- What do normal and abnormal results really mean?
- Common questions about bone pain and myeloma
The short answer
Is my bone pain myeloma or arthritis?
Most bone and joint pain is arthritis, a strained back or worn joints, not myeloma. Myeloma is a blood cancer of plasma cells in the bone marrow, and it becomes more likely when bone pain is new, constant, worse at night, and comes with tiredness, repeated infections, thirst or kidney changes on a blood test.
How arthritis pain usually behaves
Arthritis lives in the joints: knees, hips, hands, the neck and the lower back. It is often stiff first thing in the morning or after sitting, eases as you get moving, and flares with use. It tends to build slowly over months or years, and it often affects both sides.
How myeloma bone pain usually behaves
Myeloma pain is more often in the bones themselves than in a joint. The back, ribs and hips are the usual places. It tends to be a steady, deep ache that does not settle with rest and may wake you at night. A bone can break after a minor strain, such as a cough or lifting a bucket.
Why the difference is not always clear
Myeloma is more common in older adults, the same group in which arthritis and back pain are very common. Both can exist together. That is why a simple set of blood and urine tests, not the pain alone, settles the question.
This page cannot tell you which one you have. A doctor who examines you and reads your tests can.Side by side
How does arthritis pain differ from myeloma pain?
More typical of arthritis
More typical of myeloma
Pain in the joints, often knees, hips or hands
Pain in the bones, often back, ribs or hips
Stiff in the morning, eases once you move
Constant ache that rest does not ease, often worse at night
Builds slowly over a long time
New pain that keeps getting worse over weeks
Blood counts and kidney tests usually normal
Often with low haemoglobin, raised calcium or kidney changes
X-ray shows narrowed, worn joints
Scans may show thinned bone, punched-out spots or a collapsed spine bone
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Back pain that cannot wait
If back pain comes with new weakness or numbness in the legs, trouble walking, or loss of control of the bladder or bowels, go to the nearest emergency department today or call 108. These can be signs of pressure on the spinal cord, whatever the cause. The same applies to severe confusion, extreme thirst with drowsiness, or passing very little urine. Do not wait for a routine appointment.
The common causes
What else causes bone pain besides myeloma?
Each of these is far more common than myeloma. Several can be found or ruled out with the same basic tests.
Osteoarthritis and back strain
Wear in the joints and the spine is the most common reason for aches in older adults. It is usually worse with use and better with rest and gentle movement.
Low vitamin D and thin bones
A lack of vitamin D can cause a widespread bone ache and muscle weakness. Osteoporosis, which means thin bones, can lead to a spine bone collapsing after little or no injury.
More likely with
- Little time in sunlight
- Women after menopause
- Long-term steroid use
Inflammatory arthritis and gout
Rheumatoid arthritis causes swollen, warm, stiff joints, often in the hands. Gout causes sudden, very painful swelling, often of the big toe or ankle.
Infections and other cancers
Tuberculosis of the spine is still seen in India and causes back pain with fevers and weight loss. Cancers that spread to bone, such as breast, prostate or lung, can also cause bone pain.
These need a doctor's examination and scans, not just painkillers.Leave a number, we will call you
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Finding out
Which tests tell myeloma apart from arthritis?
Basic blood tests
A complete blood count, calcium, kidney tests and an ESR or CRP, which are markers of inflammation. Anaemia, a low haemoglobin, with a raised calcium or kidney changes makes myeloma worth looking for.
Protein tests
Serum protein electrophoresis and serum free light chains look for an abnormal protein made by myeloma cells. A urine protein test may be added. These are the key tests when myeloma is suspected.
Imaging
An X-ray shows arthritis well. If myeloma is suspected, a low-dose whole-body CT, an MRI or a PET-CT looks for bone damage that a plain X-ray can miss.
Bone marrow test if needed
If the protein tests are abnormal, a small sample of bone marrow, usually from the back of the hip, confirms or rules out myeloma. It is done with local anaesthetic, which numbs the area.
Commonly believed
What do families believe about bone pain in older adults?
"Back pain at this age is normal. There is no need to test."
Much back pain in older adults is wear and tear. But new pain that is constant, worse at night or comes with tiredness, weight loss or thirst deserves a doctor's visit and simple blood tests. Most of the time they are reassuring.
"The X-ray was normal, so it cannot be myeloma."
Plain X-rays can miss early bone changes from myeloma. If the blood or protein tests point to myeloma, a more sensitive scan is needed. A normal X-ray is useful for arthritis, less so for this question.
"A raised protein on the report means I have myeloma."
A small abnormal protein is often found in people who never develop myeloma. This is called MGUS, a harmless-looking protein that is usually just watched with repeat tests. Only a haematologist can tell which it is.
"Painkillers are working, so it is only arthritis."
Painkillers ease pain from many causes, including myeloma. Relief does not tell you the cause. Some common painkillers can also strain the kidneys, so ask your doctor before taking them regularly.
Being straight with you
What do normal and abnormal results really mean?
Normal blood counts, calcium, kidney tests and protein tests make myeloma very unlikely as the cause of your pain. They do not explain the pain itself, and they do not rule out arthritis, osteoporosis, a slipped disc or a cancer that has spread from elsewhere. If the pain continues, the search goes on in a different direction.
An abnormal result is a starting point
A low haemoglobin, a high ESR or a raised calcium has many possible causes, from infection to vitamin D treatment. Reference ranges differ between laboratories, and one result is always read alongside your symptoms and repeat tests. Do not decide what it means from the report on your own.
Who should ask about myeloma directly
If you have bone pain together with anaemia, kidney changes, a high calcium or repeated infections, it is reasonable to ask your doctor whether protein tests have been done. If they have not, ask why.
How CION can help
Dr. Basudev Pokhrel, CION's haematologist, can review your reports and tell you whether myeloma needs to be looked for. If further tests are needed, the team explains where they are done and what to ask.
Questions we are asked
Common questions about bone pain and myeloma
What does myeloma bone pain feel like?
Most people describe a deep, steady ache in the back, ribs or hips that does not ease with rest and may be worse at night or when moving in bed. Sudden sharp pain can mean a bone has cracked. Pain like this is not proof of myeloma, but it is worth telling a doctor about.
Can a normal CBC rule out myeloma?
Not fully. Many people with myeloma have anaemia or other changes on the blood count, but early myeloma can show a normal count. The protein tests, serum protein electrophoresis and free light chains, are the ones that look for it directly, alongside calcium and kidney tests.
Is joint pain ever a sign of blood cancer?
Occasionally. Leukaemia in children can cause bone and joint pain, and myeloma can cause bone pain near joints. In adults, joint pain on its own is far more often arthritis. Pain with fevers, bruising, weight loss or unusual tiredness needs a doctor's assessment and a blood count.
What is MGUS, and will it turn into myeloma?
MGUS means a small amount of abnormal protein in the blood without myeloma. It usually causes no symptoms and is often found by chance. Most people with MGUS never develop myeloma, but a small number do over time, so it is followed with regular blood tests set by your doctor.
Should I get a scan for my back pain?
Most back pain improves without a scan. A scan is useful when pain is new and persistent in an older adult, wakes you at night, follows a minor strain, or comes with weakness, weight loss, fevers or abnormal blood tests. Your doctor decides which scan fits the question being asked.
Which doctor should I see for bone pain?
Start with your family doctor or a physician, who can examine you and order basic tests. An orthopaedic doctor or a rheumatologist, a joint specialist, suits arthritis. If the blood or protein tests look abnormal, a haematologist is the right specialist to see next.
Can vitamin D deficiency cause pain like myeloma?
Low vitamin D can cause a widespread bone ache and weak muscles, and it is common in India. It does not cause the abnormal protein, kidney changes or bone spots seen in myeloma. A blood test can check vitamin D, but treat a low result only on your doctor's advice.
My father has bone pain and kidney problems. Should we worry?
Kidney problems have many common causes, such as diabetes and high blood pressure. Together with bone pain, anaemia or a high calcium, though, myeloma should be checked for. Ask his doctor whether protein tests have been done. They are simple blood and urine tests.
Your Haematologist
Meet CION's haematologist. One specialist for your blood report and your plan.
Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Addressed by landmark, because that is how this city navigates. A haematology consultation can be booked at any of these centres through one helpline, and your team will tell you where each test or treatment takes place.
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Sources
- NHS — Multiple myeloma
- Cancer Research UK — Myeloma
- Blood Cancer UK — Myeloma
- NHS — Osteoarthritis
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Low Haemoglobin: When It Points to CancerIf bone pain came with a low haemoglobinWhich Symptoms Combined Warrant Urgent TestingWhen pain comes with other warning signsWhat a Normal Blood Test Does and Does Not Rule OutIf your counts were normal but the pain continuesBlood cancer guideMyeloma and other blood cancers explained
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Worried about bone pain and a blood report?
Share the reports with us. A CION haematologist can tell you whether myeloma needs to be looked for and what to ask next. One helpline serves every CION centre.