Q: My mother got her blood tested recently with the complaints of abdominal and back pain (since 2 or more years and intensified recently). The blood tests indicated that the total protein level is 10.40 g/dl (Albumin 4.0 g/dl; Globulin 6.4 g/dl; A/G Ratio 1:1.6) and the Erythrocyte Sedimentation Rate (ESR) is 112 mm/hr. The serum protein electrophoresis revealed hyperproteinemia, hyperglobulinemia, severe increase in gamma globulins but M-Protein was absent. Alkaline phosphatase and urine analysis studies were normal. The doctors suspected multiple myeloma and suggested bone marrow examination which was reported as normocellular marrow with no specific lesion while bone marrow trephine biopsy showed no evidence of myeloma. The bone scan was normal. Also abdomen and pelvis X- ray, USG of abdomen and endoscopy are normal. Then she was tested for TB and got normal result. Hence, I request you to kindly let me know the reason for the total protein and ESR elevation and the pain in abdomen, pelvis and back with possible treatment measures? She got mumps one and half month back.

A:A very prolonged history of steadily persisting and then increasing pain suggests an underlying neurological problem of sensory perception that may respond to analgesics, antispasmodics or antidepresants. However, a full medical exam and appropriate tests may be needed every 4-6 months for several years to make sure there is no occult infection such as lymphoma or chronic infection such as tuberculosis. Abnormal serum proteins and an increased sedimentation rate raise the concern that there may be such an underlying problem. However, negative findings indicate that symptomatic therapy and follow up are adequate for keeping serious disease under review. It is possible that no serious cause will ever be detected and that symptoms will gradually resolve.