Age-time patterns of cancer to be anticipated from exposure by Pierce D. A.

By Pierce D. A.

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Bone is more frequently a site of metastases than anticipated based on percent of cardiac output and blood supply [3]. The distribution based on bone scans are: 39% vertebral, 38% ribs and sternum, 12% pelvis, and 10% long bones [3]. Pain is experienced in only a minority of bone metastases. Painful symptomatic vertebral metastases and spinal cord compression occur more often with thoracic spine metastases (70%) than lumbar (20%) or cervical spine (10%) [40]. Bone scan positivity is due to reactive osteoblastic activity around metastases, which does not occur with osteolytic metastases.

Davis MP, Lasheen W, Gamier P. Practical guide to opioids and their complications in managing cancer pain. What oncologists need to know. Oncology 2007, 21(10):1229–38. Hagen NA, Biondo P, Stiles C. Assessment and management of breakthrough pain in cancer patients: current approaches and emerging research. Curr Pain Headache Rep 2008, 12:241–8. Carr DB, Goudas LC, Balk EM, et al. Evidence report on the treatment of pain in cancer patients. Evidence report on the treatment of pain in cancer patients.

Sixty to 80% will experience relief. Adjuvant analgesics such as bupivicaine, clonidine, or the calcium channel blocker ziconotide are frequently needed to improve pain control. Spinal opioid rotation (morphine to hydromorphone or fentanyl) may improve pain that is not responsive to morphine [54]. Epidural opioids are used in those with only a 20 few weeks to survive, whereas intrathecal opioids are preferred in those expected to survive months. In general, 1% or less of the oral morphine dose is needed for effective spinal analgesia.

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