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Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.

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Steroid-Induced Avascular Necrosis, Myeloma

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Shoulder pain can be a symptom of Multiple Myeloma or a side effect of high-dose steroids given to treat the disease. High-dose steroids can result in avascular necrosis.

My diagnosis of multiple myeloma led to induction chemotherapy, stem cell mobilization and an autologous stem cell transplant all in 1995.  

Included with each chemotherapy cocktail was dexamethasone, a corticosteroid. Dex. was a component throughout my conventional oncologic treatments from my original diagnosis through diagnosis of end-stage cancer from 2/94-9/97.

Steroid-induced avascular necrosis on the other hand, is a long-term side effect of steroid use, according to the studies linked below.

Learn about my long-term myeloma survivor experience- click now 

In order to address my mantra “I wish I knew then what I know now” this post will define AVN, discuss the pros and cons of high-dose steroids in cancer therapy, discuss possible therapies shown to heal AVN and list several blog posts that I’ve written documenting my experiences with AVN.

For the record Corticosteroid-induced Avascular Necrosis is not a disease. It is a long-term side effect of corticosteroid therapy. This long-term side effect, whether shoulder, hip or knee, has been well documented and known about for years. Short, long-term and late stage side effect result from toxic therapies.

Benefit of high-dose steroid therapy?

A few years ago, I came upon a study that cited curcumin as a replacement for steroid therapy for those patients who were intolerant of steroids. When I read the study, it occurred to me that steroids were not needed for the management of multiple myeloma. I don’t know about all cancers.

Further, the side effects of steroids are well documented. Lower doses reduce the risk of side effects as well as reduce the severity of side effects that do occur.

Therapies to heal steroid-induced AVN?

According to the top link below, AVN is a progressive disease. I consider myself fortunate that I did not experience bone pain for the first 25 years following the discontinuation of dexamethasone. My guess is that AVN has been lurking in/on my shoulders but never reared it’s ugly head.

Because AVN is progressive, my goal is to prevent the bone from collapsing and stabilize the pain rather than heal the AVN.

  • Rather than introduce toxic bisphosphonate  therapy as is suggested, I have been undergoing evidence-based, non-toxic bone health therapies such as curcumin, vitamin D3, DHEA, collagen, etc. The point in keeping the bone mineral density up is to prevent the shoulder from collapsing.
  • Further, I have been undergoing regular acupuncture sessions in order to enhance shoulder blood flow as well as reduce shoulder pain as best I can.
  • I underwent shockwave therapy- didn’t seem to help much but I am continuing Acupuncture.
  • For those people who have early stage AVN or who have recently finished steroid therapy, I encourage you to undergo  hyperbaric oxygen therapy ASAP.

According to the first study linked below, chances are pretty good that steroid-induced AVN started in my shoulder during the years immediately following my aggressive conventional chemotherapy in 1995.  I am writing this blog post during the summer of 2021.

As you can see, I’ve written extensively about my AVN and will continue to document my therapies, healing, etc.

  1. Avascular Necrosis in the long-term Multiple Myeloma Survivor
  2. Heal Avascular Necrosis W/out Surgery?
  3. Steroid-Induced Shoulder Avascular, Osteonecrosis: I.D. Therapies
  4. Multiple Myeloma Side Effect- Osteonecrosis of the Jaw-
  5. Healing Chemotherapy-Induced Aging-
  6. Cancer Survivors- Managing Chronic Non-Cancer Pain
  7. Multiple Myeloma Therapy- Non-toxic Bone Health
  8. Multiple Myeloma Side Effects- Acupuncture For Pain
  9. Acupuncture Can Elevate Joint Pain from Aromatase Inhibitors for Breast Cancer
  10. Cancer Survivors- Managing Chronic Non-Cancer Pain

If you’d like to learn how my evidence-based, non-toxic therapies worked- holding off bone collapsing and managing bone pain, feel free to send me an email. I will reply ASAP.

To Learn More about short, long-term and late stage side effects- click now

Thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Shoulder Osteonecrosis: Pathogenesis, Causes, Clinical Evaluation, Imaging, and Classification

“The humeral head is the second most common site for nontraumatic osteonecrosis after the femoral head, yet it has attracted relatively little attention. Osteonecrosis is associated with many conditions, such as traumatism, corticosteroid use


Corticosteroids are a common cause of atraumatic humeral head necrosis, but the exact mechanism is unknown. Hernigou4 evaluated the natural history and the rate of disease progression with a long-term follow up. The outcomes of 215 shoulders (125 adult patients) with osteonecrosis related to corticosteroids were evaluated at early stages before collapse with radiographs and MRI. With an average 15 years of follow up (range 10 to 20), there was pain in 65% of asymptomatic shoulders and collapse had occurred in 50% of shoulders. In symptomatic shoulders, collapse has developed in most at the final follow up. The time between the diagnosis and collapse was an average lof 6 years. At the most recent follow up (average 15 years), 50% of shoulders had required surgical treatment. Stage, occurrence of pain, and continuation of peak doses of corticosteroids were risk factors for progression of osteonecrosis.

The role of steroid dose remains controversial. Suspected as early as 195721, whether this is a dose response, threshold, peak-dose, or idiosyncratic phenomenon is unclear. The high dose of steroids during the first several weeks seems to be more important than the total cumulative dose. In addition, patients may have a predisposition toward osteonecrosis, with a possible genetic susceptibility for the disease…”

The Natural Progression of Shoulder Osteonecrosis Related to Corticosteroid Treatment

“Results-We observed partial or total regression on MRI only in patients with asymptomatic Stage I ON. At last followup, pain had developed in 98 (74%) and collapse had occurred in 71 (54%) of the 132 previously asymptomatic shoulders. Of the 83 symptomatic shoulders, 68 (82%) had collapsed at the final followup. The time between diagnosis and collapse averaged 10 years for patients with symptomatic Stage I ON and 3 years for patients with symptomatic Stage II ON…

Spontaneous size reduction was observed only in asymptomatic patients and within 5 years after the beginning of steroid treatment. For the other patients, the initial size of the lesion, its location, and the continuation of peak doses of corticosteroid determined the risk of progression of the disease.

For the majority of the patients, asymptomatic or symptomatic ON of the humeral head related to corticosteroid treatment should be considered a progressive disease, with substantial clinical and radiographic progression of the disease within 15 years, even if treatment with corticosteroids has ceased…”


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