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Bone Metastatic  Cancer Pain

About Bone Metastatic Cancer Pain

Bone Metastatic Cancer is when cancer cells from a region spread to the bone causing too much bone to be made or broken down, as a result, it causes problems such as bone pain, nerve paralysis or hypercalcemia. While it can happen in all types of cancer, it is especially likely to happen in prostate cancer (18% to 29%), followed by lung, breast and colon cancer.

What Causes Bone Metastatic Cancer Pain

Metastatic cancer is primarily caused by the spreading of the cancer cells to the bones. Some experience it after cancer therapy, while others experience it at the beginning stage of cancer, there is no clear explanation on what causes it to affect certain individuals more than others. The following are some types of cancer that can cause bone metastatic cancer

  • Breast cancer
  • Liver cancer
  • Colon cancer
  • Lung cancer
  • Prostate cancer
  • Thyroid cancer

Symptoms Of Bone Metastatic Cancer Pain

Bone pain is a typical symptom of bone metastatic cancer pain, this is likely due to bone fractures, aggravated by a fall or injury. The weakened condition of the bone will also increase the severity of the pain and vulnerability to any form of physical trauma.
Some other descriptions of Bone Metastatic pain include a dull, boring pain that worsens at night. Sharp pain can be precipitated by movement such as turning in bed or lying on the affected bony area, in the background of constant dull aching pain. Even without fractures, bone infiltration by the cancer cells will cause local inflammation and expansion within the bone matrix, giving rise to bone and joint pain.
Other Symptoms
Apart from daytime or movement pain, some other symptoms of bone metastatic cancer include night pain, unintentional weight loss, pain with weight-bearing or an enlarging mass at the affected area. Unexplained dehydration is often associated with bony metastatic cancer. If any of these symptoms are present, visit a doctor or physician to obtain a detailed physical exam early to prevent further damage.

When Should I Seek Medical Attention?

You should seek medical help when:

  • Swelling of the wrist joint
  • Persistent wrist pain from moving the thumb
  • Inability to rotate the wrist
  • Tenderness at the location of pain

A Message About Bone Metastatic Cancer Pain

The hallmark of metastatic bone cancer is nighttime pain, affecting one’s sleep. It will cause rest pain while lying down, which is contrary to evoked pain. Sleep interruption from pain is often taken as a prelude to further evaluation of the pain history, to exclude sinister causes of cancer pain.

This type of pain is often rated as the most distressing of all pain, with pain reported as 9/10 or 10/10 (10 being the worst pain possible). No position seems to provide any pain relief. Standard painkillers often are inadequate to cover the intense bony pain. There may be a need to cover multi-modal analgesia, including hydration to bring down the high calcium level.

In refractory difficult cancer pain, there is a need for advanced pain modalities such as chemical neurolysis or spinal morphine anaesthetic infusion. Patients who are not responding to opioids such as morphine or have too many side effects will benefit from these treatments.

Diagnosing Bone Metastatic Cancer Pain

Bone metastatic cancer pain can be discovered by indicators such as calcium level (hypercalcemia) or spinal compression, however, it requires adequate evidence and experience to diagnose the illness. Here at Singapore Paincare, our team of experienced primary care and specialist pain care doctors, together with the Oncologist, will conduct a thorough diagnosis. This includes a physical exam, questions about your symptoms and an evaluation of your medical history. An X-ray or CT scan may be needed to evaluate or confirm the degree of the illness.

What Treatments Are Available for Bone Metastatic Cancer Pain?

Treatment cannot cure bone metastatic cancer pain but it can relieve pain and improve your quality of life. Studies have shown that improved pain relief will have a direct impact on the life expectancy and longevity of the patient. Good pain relief will improve the overall immunity and energy level of the patient. At Singapore Paincare, we strive to treat your pain with the least invasive option possible after accurately identifying the cause. Our approach to pain resolution focuses on the removal of pain generators via specialised injection and minimally invasive procedures. Combined with pharmacological treatments, and cognitive and physical rehabilitative therapies, we help patients to improve functions and prevent pain from recurring.

Non-Surgical Treatments for Bone Metastatic Cancer Pain

Chemical Neurolysis
Neurolysis is the use of medications/chemicals to block off the pain and “burn off” further transmission of pain signals from the abdomen.; A one-time specialised injection will introduce chemical agents to the painful nerves, to treat the pain by blocking the nerve transmission. These are targeted at sensory nerves not involving motor function, without causing weakness or paralysis.
Endoscopic Resection

Endoscopic Resection is done when the cancer is diagnosed in its very early stages. The procedure does not require an incision in the skin, instead, an endoscope is used to probe into the stomach to remove the tumour or cancerous region.

Chemotherapy is the use of drugs to destroy cancer cells. This is done before surgery to prevent the cancerous cells from dividing and spreading or after surgery to get rid of any remaining cancerous cells. The combination of drugs used includes cisplatin, oxaliplatin, fluorouracil and several other drugs.

Drugs and medications are an integral part of cancer treatment. Pharmacotherapy and targeted therapy introduce an array of drugs to boost the body and limit damage to the surrounding cells. Our specialists offer specialised treatments such as bisphosphonates (hormone therapy) which slows bone damage or radiopharmaceuticals (radioactive element drugs) that target cancer cells. Steroids are also used to reduce the bony swelling caused by metastatic bone filtration.

Immunotherapy is an alternative if chemotherapy remains ineffective, it is a biological therapy to boost the body’s defence against cancer. The line of drugs used is different in comparison to chemotherapy and can cause side effects such as diarrhoea or weight changes.
Radiation Therapy
Radiation is the use of high-energy x-rays on the affected area to destroy the cancer cells. Side effects of the therapy include skin reactions, stomach discomfort and loose bowel movement.
Neurospan Radiofrequency Ablation

Radiofrequency ablation is the use of heat to remove structures, which can be a simple procedure to relieve pain. A one-time injection of radiofrequency ablation can stop the painful nerve from giving pain signal transmission. This may be repeated every 3 – 6 months.

Spinal Morphine Anaesthetic Infusion
In difficult cancer pain, refractory to opioid therapy or standard painkillers, patients may benefit from a targeted infusion of morphine and local anaesthetic into the spinal cord. There are many pain receptors involved in pain transmission in the spinal cord. The infusion of micro-doses of these medications will have profound pain relief without high doses of opioid side effects. The morphine requirement will be reduced by 80 – 90% due to the analgesic amplification of stopping the pain transmission.
Once the infusing catheter is placed within the correct level of the spine, the delivery of the medications can be made via a pump either externally or implanted internally. The amount of medications will be titrated according to each individual’s requirement.
Palliative Care and Dietary Management
Our specialists offer supportive care, it helps to cope with the condition by addressing the emotional, social and financial aspects of cancer. We will also offer dietary management advice such as decreased alcohol consumption or supplements to help the body break down the food effectively. Each session is catered to provide the best outcome and differs for each patient.

Surgical Treatment for Bone Metastatic Cancer Pain

In the case that all methods are exhausted, surgery may be recommended. As surgery always comes with associated risks, complications and downtime, it may not be suitable for everyone. You should carefully weigh the decision before deciding to go under the knife by considering the pros and cons of both non-surgical methods and surgical reconstruction

Surgical treatment
If all forms of conservative treatments are ineffective, doctors may recommend debulking surgery. This is done to reduce the tumour load or palliative surgery to offload any pressure effect on surrounding structures.

If the bones have fractured, alternative surgeries such as reconstruction or the use of metal plates, screws, wires, nails or pins will be done to stabilize the structure.

How Can I Prevent Bone Metastatic Cancer Pain?

Doing a yearly health screening helps to detect cancer. In the early stages of cancer, systemic treatments may be prescribed in addition to surgery to reduce metastasis risks.

Get Your Pain Resolved

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