Page 166 Guide to Pain Management in Low-Resource Settings

154 M. Omar Tawfi k

Pearls of wisdom References

Osseous metastasis should be expected when vague [1] Bruera E. Bone pain due to cancer. In: Refresher course syllabus. Seattle:
IASP; 1993. p. 237–44.
pain starts to develop in patients with a history of treat- [2] Clavel M. Management of breast cancer with bone metastases. Bone
ed or untreated cancer. 1991;12(Suppl 1):S11–2.
[3] Demers LM, Costa L, Lipton A. Biochemical markers and skeletal me-
Bone scans can detect osseous metastasis earlier tastases. Cancer 2000;88: 2919–26.
[4] Koltzenburg M. Neural mechanisms of cutaneous nociceptive pain.
than ordinary radiographs.
Clin J Pain 2000;16:S131–8.
Attempts to detect hypercalcemia should be done [5] Mercadante S. Malignant bone pain: pathophysiology and treatment.
Pain 1997;69:1–18.
in every case. Early effi cient treatment should start, and [5] Mercadante S, Radbruch L, Caraceni A, Cherny N, Kaasa S, Nauck F,
bisphosphonates are the best remedy. Ripamonti C, De Conno F; Steering Committee of the European Asso-
ciation for Palliative Care (EAPC) Research Network. Episodic (break-
A high success rate after surgical intervention has through) pain: consensus conference of an expert working group of the
European Association for Palliative Care. Cancer 2002;94:832–9.
been reported, leading to improved patient survival. [6] Mundy GR. Mechanisms of osteolytic bone destruction. Bone
More than 60% of patients benefi t from surgical decom- 1991;12(Suppl 1):S1–6.
[8] Portenoy RK, Hagen NA. Breakthrough pain: defi nition, prevalence and
pression and obtain adequate neurological recovery, characteristics. Pain 1990;41:273–81.
although patients with rapid neurological compromise [9] Tubiana-Hulin, M. Incidence, prevalence and distribution of bone me-
tastases. Bone 1991;12(Suppl 1):S9–10.
have a worse prognosis.
If only symptomatic treatment is available, NSAIDs
Websites
and opioids, and in some cases coanalgesics, may im-
prove pain at rest, but pain on movement will be hard http://patient.cancerconsultants.com/cancertreatment_bone_cancer.
to control suffi ciently without mechanical stabilization. aspx?linkid=53855