[earle58]

Originally Posted by erroridiot

When I am dying and in pain of any kind including bone, please do not give me Ibuprofen. It will not help.

i assure you, antiinflammatories are not the primary source of treatment.
and no one would ever give you motrin to treat pain.
but they do work synergistically in addressing the various components of pain.
consider it a supplemental therapy.

leslie

[206bones]

It has been my experience that bone pain responds well to the use of steroids, as they provide anti-inflammatory relief. Again, stomach upset is the downside. When using a steroid, add zantac or the like. If you use Hospice Pharmacia, they are wonderful at assisting you with questions like this. or go to www.hospicepharmacia.com they're a great resource.

[introspectiveRN]

I would recommend scheduled doses of an NSAID 'round the clock (ibuprofen is now the gold standard for bone met pain...go figure). If this gives "decent" relief but leaves wiggle room- I would also add a steroid. In addition, since pain can be perpetuated by anxiety, I would probably also start with something milder like 0.25 of Ativan QHS scheduled and B to T ID prn. How goes the response to narcs so far?

[mc3]

Agree c Leslie and 206Bones...has worked very well for me. Have also used methadone but lots of docs are afraid of it...
mc3

[206bones]

You know, I've not had much experience using methadone. It's cheaper, works well I hear, but I've also heard it's difficult to titrate. I guess I've just always stuck with what I know. What's your call on methadone?

[CANRN]

Originally Posted by 206bones

You know, I've not had much experience using methadone. It's cheaper, works well I hear, but I've also heard it's difficult to titrate. I guess I've just always stuck with what I know. What's your call on methadone?

We use Methadone almost exclusively in our hospice. Our pharmacy is great at helping us with titration and we all know how to titrate it and how often etc. Follow up on Methadone is very important. Once we get them at the proper dose, our patients are VERY comfortable and do very welll with it. It's a great medication when used properly and with proper education.

[earle58]

we use a ton of methadone also.
but esp during the titration period, continuous monitoring is essential.
it has a very slow onset with a long duration.
and many meds change its absorption, metabolisma and distribution...

esp when given with the benzos.
be very, very careful with this combo.

but still, it's one of the most effective narcotics around.

leslie

[saribeth]

We have had really good results with Dexamethasone 4mg bid..it increases appetite and gives them a feeling of "well being" (oxymoron I know)! What about a fentanyl patch starting with 75-100 mcg and the percocet for BTP...maybe with the patch she will not feel as if she is taking so many oral meds???? All the best

[206bones]

What would you say the benefit of methadone is over Morphine LA, oxycontin etc??.

[Em1995]

I have found that adding motrin to a long-acting pain med is very effective for bone mets. And, adding prednisone or decadron is an added plus. Can someone explain why methadone works better? We rarely use methadone. I used it once for a man who had terrible neuropathic pain and it worked beautifully. It was my understanding that methadone is more effective for neuropathic pain.
Thanks!