Bone Pain

I have a new patient that I am seeing who is having a hard time adjusting to any new pain meds being added to her current dosages.

I have her on oxycontin 120 mg bid and hydrocodone 7.5\325 2 every 4 hours and oxycodone 5 mg 2 every 2 hours for breakthrough (tho its difficult to get her to take it). She continues to have breakthrough hip pain due to bone mets. Seems like every time I do|try to change something it really gets her anxious. I tried a medi planner she did not like that at all. now I have made a written list of everything she is to take and at what time.

My main trouble is getting this bone pain managed. Any suggestions? By the way if you couldnt tell. I have case managed exactly 1 week and I really want to do my very best for this patient.

Welcome all suggestions.

Thank you

Try adding Ibuprofen 400-800 mg QID, with meals, also comes in liquid. Adding a steriod might also help, but start with Ibuprofen first.

May I suggest that you titrate her Oxycontin based on her total dose of BTP meds, you could go to q8 to try to manage pain better; I would stop the the hydocodone and stay with the oxycodone for BTP; based on the total dose of Oxycontin (which doesn't seem sufficient) her BTP dose would be 20-25 mg of oxycodone. If this doesn't work, I agree that it may be beneficial to add a steroid. Does your patient have an allergy to morphine? If not, you may want to switch over for cost effectiveness. Best wishes and keep up the good work!

I agree with adding a NSAID, though they could be hard on the stomach. We usually use Trilisate which is not as hard on the stomach and use 500mg 4xdaily. I also agree with just using Oxycodone for break through pain at a dose of at least 20% of the total long acting Oxycontin daily dose. Some have found Methadone to be more helpful, but this requires careful monitoring and a doc that knows how to use it and titrate it.

right, ibuprofen will bridge the pain gap. but you may also need to add some oxyfast or methadone as well.

is she allergic to morphine?

i have a new patient that i am seeing who is having a hard time adjusting to any new pain meds being added to her current dosages.

i have her on oxycontin 120 mg bid and hydrocodone 7.5\325 2 every 4 hours and oxycodone 5 mg 2 every 2 hours for breakthrough (tho its difficult to get her to take it). she continues to have breakthrough hip pain due to bone mets. seems like every time i do|try to change something it really gets her anxious. i tried a medi planner she did not like that at all. now i have made a written list of everything she is to take and at what time.

my main trouble is getting this bone pain managed. any suggestions? by the way if you couldnt tell. i have case managed exactly 1 week and i really want to do my very best for this patient.

welcome all suggestions.

thank you

No she is'nt allergic to Morphine, but she really resists my doing alot of changing of her meds so I am trying to ease her along. I did start her on Trilasate 750 mg BID today, trust me she wasnt that pleased. I hope it makes some inprovement i told her to start tonite and take another dose in the morning then I plane to see her tomorrow afternoon.

My next plan is to get rid of the hydrocodone and replace with the oxycodone.

I will see what tomorrow brings.

thanks for all your advice

SUE

Oxycodone, morphine, and hydrocodone could all be given in staggering amounts and they would not touch bone pain. They are for visceral pain. Prednisone works great for bone pain related to mets, doesn't work well for arthritic type pain. I would definitely try Prednisone Qam and Qnoon. 10-20mgs.

I've had really good consistent results with hydromorphone when you're dealing with bone pain/bone mets. Absolutely wonderful results.

HTH

Cheryl

There are more potent (and more effective) NSAIDS available at minimal cost for bridging the bone pain gap, such as Voltaren. A one month supply of this medication is available at Walmart/Sam's Club for $4/per 30 day supply.

Ultram and Naprosyn are also more potent than Ibuprofen.

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

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

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.

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?