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Query: UMLS:C0153690 (bone metastases)
 6,382 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Causes of pain were analysed in 200 patients referred to a specialized cancer pain clinic. Pain caused by tumour growth was found in 158 patients, pain secondary to cancer or its treatment in 116 patients and pain unrelated to cancer in 33 patients. Visceral involvement (74 cases), bone metastases (68 cases), soft tissue invasion (56 cases) and nerve/plexus pressure or infiltration (39 cases) were the most frequent causes of pain due to tumour growth. Myogenic pain (68 cases) was the most frequent cause of secondary pain. The patients presented with a multitude of different combinations of causes of pain, the majority having at least two separate causes. Since pain treatment in cancer patients should be determined by its aetiology, a detailed analysis of the pain condition in each patient should form the basis for a rational therapy.
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PMID:Pain causes in 200 patients referred to a multidisciplinary cancer pain clinic. 186 77

Several animal studies have demonstrated that pain is modulated by spinal mechanisms involving prostaglandins and that acetylsalicylic acid (ASA) administered intrathecally has an analgesic effect. We report our experience of this treatment in 60 patients with proven and advanced cancer. An isobaric solution of lysine acetylsalicylate was administered by lumbar puncture in doses ranging from 120 to 720 mg of ASA. The results were evaluated using the habitual criteria: scoring system, behaviour, consumption of analgesic drugs. In this trial the method proved astonishingly effective (78% of the cases). Analgesia was strong, almost immediate and without influence on motricity. No thermic or neurovegetative changes were noted. The effect of one injection lasted from 3 weeks to 1 month on average; it was reproduced and often more prolonged after a repeat injection. Pain associated with bone metastases seems to constitute the best indication, notably in breast and lung cancer and in myeloma. Visceral (pancreas) or neural pain requires higher doses to respond. Failures (22%) were due to such factors as insufficient dosage at the very beginning of our experience or severe depressive syndrome. The perineal and sphincteral pain of rectal cancer often resists treatment. This simple, inexpensive and very effective method with no other complication than a frequent tendency to fatigue should rank among other analgesic measures in cancer. The lack of respiratory depression is a major advantage over catheter spinal opiate analgesia. We consider that its main indications are pain associated with osteolytic metastases of adenocarcinomas, and myelomas. Owing to the absence of formal toxicological data, its use must be limited to cancer pain and to patients with a life expectancy of less than 2 years.
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PMID:[Chronic refractory pain in cancer patients. Value of the spinal injection of lysine acetylsalicylate. 60 cases]. 295 75

Bony metastasis is the most common cause of cancer pain. Strontium-89 (Sr-89), or Metastron, therapy has been shown to be effective for the palliation of pain due to skeletal metastases. By reducing opioid analgesics intake and restoring mobility, Sr-89 improves the patient's quality of life. Sr-89 is given conveniently as an outpatient procedure, and when necessary it can be repeated at 3-month intervals. Sr-89 is useful as an adjunct to local external beam radiation (EBR) because Sr-89 will target all skeletal metastases, including those not included in the EBR field. Because Sr-89 is a beta-emitting radionuclide with a long physical half-life (50.5 days), precautions should be taken by the caretaker(s) against Sr-89 contamination from the patient's blood or excretions, particularly if the patient is incontinent.
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PMID:Palliation of bone pain in patients with metastatic cancer using strontium-89 (Metastron). 754 83

Although the pain-relieving activity of salmon calcitonin has been mainly demonstrated for painful bone metastases it has been postulated that the drug possesses a central analgesic activity which is independent of the opiate receptor system. Thus, 16 patients with neuropathic cancer pain due to radicular compression by extraskeletal metastases, and without the possibility of any specific anticancer treatment, entered the study. Of the 16, 11 were pretreated with opiate-type analgesics. Salmon calcitonin was applied once daily at a dose of 200 IU in 500 ml 0.9% NaCl infused over 1 h. The total duration of the treatment was 20 days. The pain-relieving effect was classified as very good, good, moderate and bad; in 10 patients it was described as bad, in 2 as moderate in 2 as good and in 2 as very good. The drug failed in 9/11 opiate-pretreated patients. It is suggested that salmon calcitonin pain-relieving activity might depend on the tumor type, previous pain-relieving drug intake and site of metastatic disease.
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PMID:A pilot study to assess the efficacy of salmon calcitonin in the relief of neuropathic pain caused by extraskeletal metastases. 815 61

Fourty-eight patients with stage D2 prostate cancer, initially treated with endocrine therapy at the University of Tokyo between 1981 and 1990, were followed up and analysed. For the assessment of a subjective response, pain score, narcotic score, and performance stages (PS) were used. Of the fourty-eight patients, twenty-one suffered from cancer pain due to bone metastases. These patients showed significantly (p < 0.01) more lesions of bone metastases and higher PS, compared with patients without cancer pain. The progression free survival of these patients was significantly (p < 0.01) lower than that of patients without cancer pain, although the actuarial survival was not significant. In twenty-one patients with cancer pain, the objective and subjective response rates to endocrine therapy were 75% and 86%, respectively. The duration of pain relief was 1.25-54 (median 19) months. Those rates to anti-cancer chemotherapy in refractory patients (8 patients) previously treated with endocrine therapy were both 25% and those to additional administration of flutamide (FUL) or diethylstilbestrol (DES) in refractory patients (6 patients) were 33% and 100%, respectively. Although the duration of pain relief was 0.78-8 (median 2) months, the additional administration of DES or FLU led to pain relief and improved quality of life (QOL) in all 6 patients. Endocrine therapy such as LH-RH agonist and non-steroidal pure anti-androgen, which has no severe side effects, would be of great usefulness in stage D2 prostatic cancer patients with pain on the basis of efficacy and safety.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Objective and subjective response in stage D2 prostate cancer patients with cancer pain]. 817 80

This survey was designed to investigate the current status of the management of cancer pain in Finland. In 1995 a questionnaire was randomly sent to 5% (n = 546) of Finnish physicians, excluding specialists not expected to treat cancer patients. Two previous surveys, using the same questionnaire, were conducted in 1985 and 1990 by Vainio. The response rate was 53%. Seventy-nine percent of the respondents treated one or less than one cancer patient a week. Sixty-seven percent of them assessed the severity of cancer pain in their patients as being at least moderate. In 10 years, the proportion of physicians suggesting the WHO analgesic ladder principle to their 'typical cancer patient' had increased from 12% to 28%. At the same time, the suggestions of 'analgesic' without definition had decreased from 48% to 6%. Three simulated patient cases were presented. The mean daily dose of opioids suggested for severe terminal cancer pain corresponded to 72 (18-300) mg of intramuscular morphine in 1995, being only 39 (1-77) mg in 1985 for the same simulated patient case. Continuous infusion of opioid was recommended by 59% of the respondents. Non-steroidal anti-inflammatory drugs as the treatment of choice for bone metastases pain in a patient with breast cancer, was recommended by 68% of the respondents. In the case of local severe pain due to recurrent rectal cancer, 63% of the physicians suggested anaesthetic intervention. Insufficient pain relief and lack of experience were the most common difficulties in pain management. Only one-third of the physicians thought that they had enough time and ability to give sufficient psychological support to their patients.
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PMID:Developments in the treatment of cancer pain in Finland: the third nation-wide survey. 915 Feb 91

The scope of supportive care and cancer rehabilitation is very wide and heterogeneous. In this review we focus on nutritional aspects, sexual and gonadal function, psychological rehabilitation, treatment of cancer pain, and rehabilitation of patients with bone metastases. The anorexia-cachexia syndrome is a particularly frequent manifestation of cancer that profoundly affects body image and significantly impairs quality of life of cancer patients. However, enteral feeding through nasogastric tubes, gastrostomies, or jejunostomies is an efficient method for providing long-term enteral nutrition at home and for contributing to complete rehabilitation after cancer therapy. Recent effort has focused on nutritional pharmacology and on the optimalization of the use of appetite-stimulating drugs, such as progestational agents. The psychological components of cancer, anticancer therapy, and quality of life have now been widely recognized and studied. Effective pharmacological and psychotherapeutic interventions help patients and their family to better adjust to the chronic stress of cancer, but more specific determinants of psychological morbidity should be developed. In particular, the safe and efficient use of the most recent classes of antidepressants and anxiolytics should be urgently studied. More than 90% of cancer patients present one or more pain syndromes during their illness. The adequate use of drugs is the cornerstone of treatment. The development on new molecules and new routes of administration opens interesting perspectives for cancer pain control. Bone metastases are the source of considerable morbidity. Intravenous bisphosphonates have been successfully used for the treatment of the symptoms of metastatic bone disease, especially bone pain. Moreover, monthly pamidronate infusions in addition to chemotherapy reduce the mean skeletal morbidity rate by more than one third and contribute to the rehabilitation of cancer patients with bone metastases from breast cancer or with multiple myeloma.
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PMID:The concept of rehabilitation of cancer patients. 925 83

Radiosurgical hypophysectomy using Leksell gamma knife was performed to the patient with cancer pain from bone metastases of the breast cancer, relief of the pain was achieved. Patient survived 26 months after hypophysectomy. Review of the literature concerning relief of the pain after hypophysectomy is presented.
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PMID:[Radiosurgical hypophysectomy in painful bone metastases of breast carcinoma]. 958 99

The role of nonsteroidal anti-inflammatory drugs (NSAIDs) is well established in the treatment of cancer pain. This class of drugs is considered particularly effective in pain due to somatic mechanisms, although proof of this observation is lacking. To ascertain whether NSAIDs are more effective in specific nociceptive forms of cancer pain, they were administered alone or added to opioids in 32 patients with a sole pain mechanism, somatic pain due to bone metastases (17 patients) or visceral pain (15 patients), respectively. Pain intensity, mean doses of opioids used, and symptoms were recorded after starting NSAID. A significant reduction in pain intensity was found at 3, 7, and 14 days. No differences in pain intensity between the two groups were observed. However, patients with a visceral mechanism required higher opioid doses after a week of treatment. No differences in adverse effects were reported. NSAIDs may be useful drugs in the management of cancer pain, regardless of the mechanism of pain involved. The incidence of adverse effects during prolonged administration should be assessed in future studies.
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PMID:Analgesic effects of nonsteroidal anti-inflammatory drugs in cancer pain due to somatic or visceral mechanisms. 1035 13

Control of malignant pain and related symptoms is paramount to clinical success in caring for cancer patients. To achieve the best quality of life for patients and families, oncologists and palliative care clinicians must work together to understand problems related to psychologic, social, and spiritual pain. Pain is the primary problem targeted for control using the World Health Organization's (WHO) analgesic ladder. This article focuses on increased knowledge of analgesic action that may enable expansion of the WHO analgesic ladder to fulfill the broader objectives of palliative medicine. We discuss clinical experience with several classes of drugs that are currently used to treat cancer pain: 1) nonsteroidal anti-inflammatory drugs (NSAIDs), with emphasis on cyclooxygenase-2 (COX-2) inhibitors; 2) opioid analgesics, with specific emphasis on methadone and its newly recognized value in cancer pain; 3) ketamine, an antagonist at N-methyl d-aspartate (NMDA) receptors; and 4) bisphosphonates, used for pain resulting from bone metastases. New concepts that compare molecular actions of morphine at excitatory opioid receptors, and methadone at non-opioid receptor systems, are presented to underscore the importance of balancing central nervous system excitatory (anti-analgesic) versus inhibitory (analgesic) influences.
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PMID:Advances in cancer pain management. 1112 64


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