I've been a nurse for umpteen years, and a hospice nurse for 6. My impression with bone pain from mets is that ibuprofen works better than decadron, along with a narcotic (the pts are always on narcs to begin with, so I don't have experience with Ibuprofen without narcs).
Somehow, there's a belief that, after narcotics, Decadron is the first line for bone pain, because it's "more of an anti-inflammatory". True, but it's NOT an analgesic. I've had several cases where adding ibuprofen to the mix brought dramatic relief, but there's resistance to combining Decadron and IB because of GI distress and bleeding risk. (I find this risk/benefit ratio pretty acceptable, personally, as do my patients.) I'd much rather toss the Decadron and use IB, if forced to choose.
My questions: Is it common practice to combine Decadron AND an NSAID with an opiate? From comments on this forum, it looks to be.
Any thoughts about which opioids are most effective for bone pain?
Any experience with lidocaine patches? And is there a maximum dose concern with putting one on each hip?
Thanks - LOVE this site.