Pain medicine and bone mets

  1. I have a patient with lung cancer that has spread to spine. Pain is horrendous, any suggestions. Currently on Fentanly 100mcg, Percocet 10 (2) every 4hrs and Roxanol every hr as needed.

    Thanks for any help.
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  2. Visit esrun00 profile page

    About esrun00

    Joined: Jun '05; Posts: 118; Likes: 132
    RN
    Specialty: 22 year(s) of experience in cardiac, oncology

    54 Comments

  3. by   SoldierNurse22
    We used to do a lot of Oxy IR/SR for bone pain. We also have continuous basal PCA protocols that allowed us to titrate basal morphine/dilaudid drips based on respirations per minute, respiratory effort, facial expressions of pain, etc.
  4. by   Kabin
    Fentanyl might not work as well for cool skin temps or little adipose tissue. Steroids can be a useful adjuvant for bone mets.

    http://endoflife.stanford.edu/M11_pa...pendD_m01.html
  5. by   Sam J.
    The pain is 'horrendous', yet the Roxanol is 'as needed', and yet OP is asking for pain control advice (medical advice) in a nursing forum, without indicating that same OP has advised the patient's physician that her/his patient is in 'horrendous' pain? Hmm.
  6. by   SoldierNurse22
    Quote from Sam J.
    The pain is 'horrendous', yet the Roxanol is 'as needed', and yet OP is asking for pain control advice (medical advice) in a nursing forum, without indicating that same OP has advised the patient's physician that her/his patient is in 'horrendous' pain? Hmm.
    Have you never seen poorly controlled pain in oncology before? It's really not that uncommon, even when physicians are well-apprised of the fact.
  7. by   Sam J.
    I've seen it first hand zillions of times, and even in family members. The fact is, OP did 'not' mention that the physician had been informed, at 'all'. Maybe after that, and not having gotten any response, this post would be appropriate. I'm especially curious that a PRN med would be ordered 'as needed', for a patient that is in 'horrendous' pain. Not to mention the doses for all the pain meds for anyone with mets to bone are far lower than I've seen, for anyone in 'horrendous pain'. Do you not agree that Pecocet for bone pain is akin to a placebo, even? And I never said poor pain control is uncommon, it happens everywhere- but the place to start to stem that tide is with the physicians that order pain meds, am I right?
  8. by   Sam J.
    Not to mention the fact that even in this day and age some nurses hold even scheduled pain meds (much LESS take the effort to give PRNs), based on their own beliefs (patient is breathing too slow, patient is constipated, it's against my religion, or I'm just too LAZY to keep my patients medicated)? To assume doctors don't want to know if their patients are in pain (oncology or not) is not a credible suggestion. In over 30 years, I have 'never' come across such a physician.
  9. by   SoldierNurse22
    I'm not getting where you're assuming that the doc hasn't been notified. That would not be my assumption, especially with an OP that has 22 years of experience. This isn't a new member who just signed up yesterday and is asking strange questions about pain control. A look at the OP's posting history would suggest experience consistent with what's listed.

    Yeah, the doses are lower--again, lack of pain control. Egregious but not uncommon--not sure why this is a sticking point if you've seen it before. It's inconceivable, but it happens. Of course the docs are where to start. I'm not sure why you'd assume otherwise. I'm also not sure why you'd suggest that the docs don't know that their patients are in pain (as that was never indicated in my post--quite the opposite, if you'd care to review).

    As far as never having come across a physician in 30 years who didn't want to know about their patients being in pain, congrats. I have met several.
  10. by   Sam J.
    Quote from SoldierNurse22
    As far as never having come across a physician in 30 years who didn't want to know about their patients being in pain, congrats. I have met several.
    OP made no mention of contacting a physician. I don't assume anything. For a nurse to ask about pain meds makes me suspicious, more so with the lack of stating that a physician was first consulted. This is not a place to ask medical questions.

    As far as knowing doctors that don't care about a patient suffering, I suppose maybe I've been fortunate. But maybe it's also my approach, since like I said- I have never seen such a thing happen.

    And I do in fact check a poster's profile in AN before I decide whether to post my opinions, to rule out the Spam. But to suggest OP's stated history of 22 years, or even that OP IS a nurse, when none of that has been verified, is naive. I joined this forum only recently, and I can assure you that nobody asked me to verify whether or not I am a nurse, or even who I am. In fact? You continue to reply to this post, knowing nothing about me- so tit for tat.

    If a nurse has a patient that is suffering, and has to resort to an anonymous online forum for advice- trust me- I will find myself a new nurse. There is no excuse.
  11. by   Sam J.
    (And if you are a soldier? Kudos! I'm a veteran warrior, myself, and a REAL nurse- but as far as you know I could be a circus monkey, or a tattoo artist, or even your boss?)

    -Keeping it Real
  12. by   esrun00
    OK, I posted this in the hospice section, because I am now a hospice nurse and this is a hospice patient. She recently moved from another state to be with her daughter and was transferred to our agency. The doctor is very much aware of her pain. I was just wanting to know about pain control for bone pain in cancer patients, like if anyone knew of a combination of drugs that worked really well. Bone pain is the worst type of pain to help manage. Thank you for all your
  13. by   SoldierNurse22
    Quote from Sam J.
    OP made no mention of contacting a physician. I don't assume anything. For a nurse to ask about pain meds makes me suspicious, more so with the lack of stating that a physician was first consulted. This is not a place to ask medical questions.

    As far as knowing doctors that don't care about a patient suffering, I suppose maybe I've been fortunate. But maybe it's also my approach, since like I said- I have never seen such a thing happen.

    And I do in fact check a poster's profile in AN before I decide whether to post my opinions, to rule out the Spam. But to suggest OP's stated history of 22 years, or even that OP IS a nurse, when none of that has been verified, is naive. I joined this forum only recently, and I can assure you that nobody asked me to verify whether or not I am a nurse, or even who I am. In fact? You continue to reply to this post, knowing nothing about me- so tit for tat.

    If a nurse has a patient that is suffering, and has to resort to an anonymous online forum for advice- trust me- I will find myself a new nurse. There is no excuse.
    You're taking this way too seriously. A nurse posting a question in an online forum may simply be looking to compare experience with other professionals. To assume that s/he's seeking medical direction online in lieu of speaking directly with a physician is also naive. I've asked fellow nurses before what their floor's protocol is for a process I was unfamiliar with. That's not in place of speaking with physicians. It's simply for my knowledge of different processes in other areas of the hospital. It's pretty sad that you seem so convinced that the OP is trolling us for info.

    So what if the OP isn't a nurse? Who can verify who anyone really is on this forum unless you're ridiculous enough to give it away? If that were the point, the premise of this forum would change greatly. Anonymity is the idea. If you're not willing to accept that, then don't reply to posts, because you never know who you're talking to.

    As for myself, I shall remain in a cloak of mystery. All the best.
  14. by   SoldierNurse22
    Quote from esrun00
    OK, I posted this in the hospice section, because I am now a hospice nurse and this is a hospice patient. She recently moved from another state to be with her daughter and was transferred to our agency. The doctor is very much aware of her pain. I was just wanting to know about pain control for bone pain in cancer patients, like if anyone knew of a combination of drugs that worked really well. Bone pain is the worst type of pain to help manage. Thank you for all your
    Hope you've seen something here that helps. Bone pain in cancer is tough to manage. I used to see docs write various combinations of meds for different patients. It really just depends on what works for each individual, and that varies from person to person and is subject to change with the disease process. The key is persistence and, of course, supporting your patient until you get a winning combination.

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