management of bone ca pain

Great question, just posting to follow thread.

Methadone often works better for bone pain than Morphine or the codones.

I have never had good luck with lidoderm in treatment of bone pain.

Any combination of the opiates, NSAIDS, and steroids may be used dependent upon your medical director, the risk factors of your patient, the goals of the patient, and the pharmacy support you get in medication management.

If the pain is related to growth of a specific lesion, radiation may palliate that symptom effectively.

Having been a hospice nurse for 16 years I have seen both work always putting something in to protect the stomach like ranitadine. If the patient is compaining about lack of appetite then the decadron is a better choice. I am a fan of ibuprfen but many docs prefer decadron. I have not seen them used together though.

Lidodrem patches work well on nerve pain. Use for muscle or bone (at least for arthritis) pain. I say this from my personal experience when my nerve pain kicks in I reach for the patches but when the joint pain is present I go for the ibuprofen. My pain doc says to use what I need and I am usually using two one on each side of my spine with pretty good results and no negative results.

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.

Lidoderm is a local pain reliever. It is useless in deep bone pain, which is deep beneath the skin. I suppose it might help with "joint" pain, but not pain from tumors of the bone. Bone pain is extremely difficult to treat, but I too have seen better results with methadone. Decadron can be helpful in reducing inflammation, but I'm not convinced that it is that effective with bone pain. It works far better when soft tissue is involved.

I currently have a patient who I have had ongoing challenges with managing bone pain. He is now on Decadron along with scheduled Methadone which appears to be effective.

i agree that steroids are preferable if appetite is nil.

other than that, i find antiinflammatories to be effective...

and yes, methadone is the opioid of choice with bone and nerve pain.

you just need to ensure dr knows how to prescribe it...tricky drug with very long half life.

leslie

Thats a good reminder, Leslie, inexperienced docs should probably not be managing methadone in the field...too dangerous.

Crazy as this sounds decadron and ibuprofen 800mg tid has worked for some of our patients.....with an opioid also, of course. .