How to take action when a bone mets patient has pain

[Danish1807]

I haven't dealt much with bone mets patients, so when I was recently asked how to take action when a bone mets patient has severe pain, I wasn't ate sure what to answer. Can anybody please refer me to pages where I can read up on it or give me some suggestions?

[icuRNmaggie, BSN, RN]

One of the most awful things that I have ever seen was a man with ca and mets to the spine brought straight up to oncology at 2 am from the ER. He was screaming in excruciating pain. The meds I gave did nothing for him. He was on a morphine gtt at a very high rate as well. The oncologist would not come in and I was a new and clueless young RN.

It was spinal cord compression and the pt was in agony. An anesthesiologist, was a pain management specialist, (thank God i went to his pain management seminar) came in when I begged the house supervisor to call him and gave him a block and it worked. He died shortly after, pain free.

I have no references to share but I would suggest you google spinal cord compression in cancer patients.

[SoldierNurse22, BSN, RN]

Pain medicines for bone metastases

http://www.boneandcancerfoundation.org/pdfs/Pain_2011.pdf

Bone metastasis Treatments and drugs - Diseases and Conditions - Mayo Clinic

Unable to link, but you can find the full text via Google search:The Management of Pain in Metastatic Bone Disease:

Sorin Buga, MD, and Jose E. Sarria, MD

OP, interestingly, Tylenol and NSAIDS are often very effective at treating pain from bone mets. Usually, as the above article states, patients are on a combination of drugs to help alleviate pain. If the cancer becomes advances or the pain becomes severe from something like spinal compression (as the PP above mentioned), then you'll start looking at drips, epidurals, spinal blocks, etc.

Chemotherapy and radiation can also be utilized to prevent the cancer from further metastasizing, though those treatments have their own nasty side effects.

You might check out the 2nd link posted as pages 2-4 give some detailed information on drugs used to treat this kind of pain. The link to the Mayo Clinic and the article referenced above also have good information.

[KelRN215, BSN, RN]

Get thee patient on a PCA ASAP. In my experience, these patients typically require heavy doses of pain meds to control their pain. I have a teenager with osteosarcoma who's been on methadone, oxycontin and is now on standing doses of MS contin.

[globalRN]

as previous posters suggested: narcotics, decadron, palliative radiation and pamridronate IV

[cancer.sucks]

There is rarely going to be an individual answer to the quesiton of managing bone metastasis. A combination of long-acting and short-acting opioids, anti-inflammatory, and steroid is usually necessary. Especially in the case of spinal metastases, there is often a neuropathic pain element as well. Medications specifically for neuropathic pain should be added to the regimen.

Unfortunately, most states have really started cracking down on the number of medications and the requirements for preauthorization of the meds. It makes it more difficult and often very expensive for pain control in this population. Make friends with whoever it is in your facility that obtains this preauthorization. You patients will benefit from it.