Bone Pain

What Is Bone Pain and How Is It Related to Chemotherapy?

Bone pain is the experience of discomfort in bones.

• Bone pain can occur as a side effect of some of the biologic response modifiers (e.g. filgrastim, pegfilgrastim, sargramostim).
• Bone pain is most likely a result of your disease, as it is often caused by damage to the nerves, soft tissues, or bones themselves.
• Sometimes people who have metastasis to bones from prostate cancer or breast cancer will experience increased bone pain when therapy with some hormone type medications (e.g. leuprolide, goserelin, tamoxifen, anastrozole) is first started.

You May Have More Bone Pain If You Have the Following Conditions:

• Your disease has spread (metastasized) to the bones as a result of your prostate, breast, or lung cancer.
• You have bone tumors or lesions from your cancer.
• You have had trauma, such as a broken bone, from your cancer, or from falling down.
• You have thinning of the bones (osteoporosis), and developed a fracture.
• You have nerve injury as a result of a spinal cord compression

Complications Of Bone Pain Include:

• Spinal cord compression -
• Each vertebrae is joined by ligaments, which make up the vertebral column.
• Damage to one or more of these bones may damage the spinal cord, and cause serious nerve injury as a result. This is called a spinal cord compression.
• If you experience a loss of sensation, extreme pain, or are suddenly unable to walk, Notify your doctor immediately!
• Hypercalcemia - is known as an elevated blood calcium level. When the level of calcium in the blood is too high, certain problems may occur. Symptoms of hypercalcemia may include:
• Frequent urination
• Poor appetite
• Nausea and vomiting
• Constipation
• Excessive weakness and fatigue
• Muscle twitching
• Confusion, or behavior changes
• If you notice these symptoms, notify your healthcare provider immediately.

What Other Things Should I Know About Bone Pain?

• Your pain may be mild, or severe. The pain may last a few minutes, as it "comes and goes" or it may be constant.
• You may be able to point out the location of your pain, on your rib, hip, leg, or back.
• You may have fever, chills, if you have an infection.
• You may have pain in your muscles, as well as your joints.
• You may be overly tired, or very weak (fatigued). It may be hard for you to do any kind of your normal activities.
• You may feel depressed if your pain is constant pain
• Symptoms of spinal cord compression (pressing on the spinal cord) may notice a band-like pain around the waist, numbness and tingling down the legs, weakness and decreased sensation of the lower extremities (legs) and later, loss of bowel and bladder control.If these symptoms occur, notify your doctor immediately.
• Symptoms of high blood calcium levels (hypercalcemia) are: frequent urination, constipation, confusion, overly sleepy, and poor appetite.
• These symptoms should be reported immediately.

Things You Can Do To Minimize Bone Pain:

Keep a diary of your pain, this information will help the healthcare provider understand your pain better and help determine the cause of your pain and be able to give recommendations for appropriate management. Things to include in a pain diary are:

• Onset - when did the pain start? What was I doing when I had pain?
• Quality - What does the pain feel like? Is it knife-like and stabbing, or dull and constant?
• Location - Where is the pain? Can I point to it with my finger, or is it spread all over?
• Intensity - How bad is your pain all the time? How bad is it with certain activities that cause you to feel pain, on a 1-10 scale, with the number "10" being the worst pain imaginable?
• Duration - How long did the pain last for? Is it while I was walking to the door, or did it continue for a while?
• Character - Does the pain come and go whenever I perform a certain activity, or is it unpredictable?
• Relieving factors - What can I do to make the pain go away? Does anything help? What have I used in the past that have worked, and does this work now?
• How is your mood? Are you depressed or anxious? Does this make the pain worse?

If your pain has been undiagnosed, your healthcare provider may order certain tests or examinations based on your pain. This may include x-rays, CAT Scans, bone survey or scan, or an MRI. Your healthcare provider will order the exams that are right for you.

If you already have a source or cause for your pain, it is important to follow your healthcare provider's recommendations. Also, continue to keep a pain diary, and chart your progress.

Other Things you can do:

Keep your bowels moving. People in pain tend to move around less, drink less fluid, and become constipated from pain medications that slow down the movement of food through your stomach. This is easily treated by:

• Increasing your daily intake of fresh fruit and fiber. Prunes, and prune juice may work for some individuals. It is important to move your bowels daily.
• If you do not move your bowels every day, your health care provider may prescribe stool softeners and laxatives to help prevent constipation. Work with your healthcare provider to develop a regimen that will work for you.
• Drink 2 to 3 quarts of fluid every 24 hours, unless you were told to restrict your fluid intake. This will decrease your chances of being dehydrated, which can lead to constipation.
• Increase your activity, if tolerated.
• People with pain, who may not be taking deep breaths, need to circulate air from the bottom of their lungs and out of your lungs (oxygenation), to prevent infection and pneumonia. Using an incentive spirometer for 15 minutes a day, twice a day, can help promote oxygenation.
• Physical therapy is important. Try to exercise, as tolerated, to maintain your optimal level of functioning. Exercise, in persons with bone problems, will help promote strengthening and bone remodeling (repair). Discuss with your healthcare provider how you can create a specific exercise program to suit your needs. Make sure to exercise, under the supervision of your healthcare provider. Walking, swimming, or light aerobic activity may help you to lose weight, and promote the flow of oxygen in your lungs and blood (oxygenation).
• If you have back pain, or pain due to bone problems, braces or assistive devices (such as walkers or canes), may help.
• If you can locate your pain, especially if it is muscle related, warm compresses may help.
• Occupational therapy (OT): you may be taught in OT how to do many tasks that you normally do, in a more effective manner.
• People who have constant pain are often overly tired. To minimize excessive tiredness (fatigue) due to pain or cancer chemotherapy:
• You should ask yourself: Am I experiencing fatigue? If so, how severe is it on a 1-10 scale? Is it interfering with my ability to function?
• It is important to weigh the value of certain activities.
• If you feel anxious, use relaxation techniques to decrease the amount of anxiety you have. Place yourself in a quiet environment, and close your eyes. Take slow, steady, deep breaths, and try to concentrate on things that have relaxed you in the past. This is called behavioral therapy.
• Participating in support groups may be helpful to discuss with others what you are going through. Ask your healthcare provider if he or she is aware of any support groups that would benefit you.
• If you are ordered a medication to treat this disorder:
• Do not stop taking any medication unless your healthcare provider tells you to.
• Take the medication exactly as directed.
• Do not share your pills with anyone.
• Many medications to treat pain may cause you to feel dizzy or drowsy. Do not operate any heavy machinery unless you know how the medication will affect you.
• Antacids, such as Mylanta®, Pepcid®, NexiumTM (and others, may change the way many medications are absorbed. If you have any questions specific to medications that may have been ordered for you, ask your healthcare provider.
• If you miss a dose of your medication, discuss with your healthcare provider what you should do.
• If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
• Keep all your appointments for your treatments.

Medications to Treat Bone Pain:

Depending on your overall health status, your doctor may recommend that certain drugs be used to help decrease your bone pain. Some of the common drugs that are used to treat bone pain may include:

• Antibiotics - If your doctor or healthcare provider suspects that you have an infection (such as osteomyelitis) that may have caused your bone pain, he or she may order antibiotics, either in a pill form or intravenous (IV). If you are prescribed antibiotics, take the full prescription. Do not stop taking pills once you feel better.
• Anticonvulsants - these medicines are used in the treatment of chronic (long-term), nerve related pain in adults.
• When there is nerve injury present anywhere in the body, certain pain receptors may create new nerve endings. The threshold for pain (the point at which you experience pain) related to the nerves, may be decreased. Therefore, pain may be noticed while you are at rest, or while you are moving, when these nerve endings are irritated.
• The exact way that the anticonvulsants, such as gabapentin (Neurontin®) works to prevent nerve related pain is unknown, but it is thought to decrease nerve pain at certain cell receptor sites, by decreasing your response to nerve pain.
• Anticonvulsants can be referred to as an "adjunct" medicine, meaning, it is used with another medication to make it work better. Many patients, in addition to gabapentin, will be on a narcotic pain reliever, such as oxycodone, or morphine sulfate. These medications will work together to better control your pain, each working in a different way.
• Antidepressants - are used to treat depression and pain in adults. People who have pain for a long period of time (chronic), become tired and depressed.
• Certain nerve signals, when activated, make pain worse, and cause more depression. Serotonin and norepinephrine are important conductors of nerve signals (neurotransmitters), which are found in the central nervous system (CNS). The places that these neurotransmitters work are highly important. These neurotransmitters contribute to depression.
• Medications, such as venlafaxine (Effexor®) works by blocking the "reuptake" of the neurotransmitters serotonin and norepinephrine, thus decreasing your depressive symptoms.
• Bisphosphonates - Cancer cells that spread to the bone can secrete (produce) substances that can cause other cells found in the bone, called osteoclasts, to dissolve or "eat away" a portion of the bone. These tumors or lesions weaken the bone and can lead to complications. Some of the complications resulting from this bone breakdown are bone pain, fractures and less commonly, hypercalcemia (increased levels of calcium in the blood).
• Bisphosphonates, such as pamidronate (Aredia®), and zoledronate (Zometa®) may be used to treat hypercalcemia (high blood calcium), and to decrease pain. Pain can be decreased by:
• Preventing bone destruction or damage.
• Preventing bone from being "eaten away."
• Which will also prevent bone fractures or breaking.
• Corticosteroids - Corticosteroids work by decreasing inflammation (swelling) in many areas of the body. The corticosteroids prevent infection- fighting white blood cells (polymorphonuclear leukocytes) from traveling to the area of swelling in your body. This means you are more prone to infection while on steroids.
• You may be taking steroids if you have a cancer that has spread (metastasized) to your spine, brain, or bone.
• Steroids will decrease the swelling in areas where tumors are located, which may decrease the pressure of the tumor on your nerve endings, and decrease your pain.
• Narcotics -The central nervous system (CNS) is a way for our brain to send messages to our body in a timely manner. It is highly alert, especially when we are experiencing pain. Many narcotic analgesic (pain medicines) work by blocking these messages, such as morphine sulfate and oxycodone.
• Make sure you discuss with your healthcare provider common side effects, such as constipation, drowsiness, nausea and vomiting, and how to control these side effects.
• Non-steroidal anti-inflammatory (NSAID) agents and Tylenol®. If you are ordered a medication to treat this disorder - such as naproxen sodium and ibuprofen, may provide relief of musculoskeletal pain.
• If you are to avoid NSAID drugs, because of your type of cancer or chemotherapy you are receiving, acetaminophen (Tylenol®) up to 4000 mg per day (two extra-strength tablets every 6 hours) may help.
• It is important not to exceed the recommended daily dose of Tylenol®, as it may cause liver damage. Discuss this with your healthcare provider.
• Your healthcare provider will discuss with you which treatments are helpful to you.
• Do not stop any medications abruptly, as serious side effects may occur.

When to Contact Your Doctor or Health Care Provider:

• If your pain is not better within 2 days of treatment.
• If you suspect:
• Spinal cord compression - the spinal cord controls movement, sensation, and other important functions. When the spinal cord and/or its nerves become squeezed, additional swelling (edema) may develop, and serious complications may occur, which may be permanent.
• Notify your doctor immediately if you notice:
• A band-like pain around your waist or chest (radicular)
• New and increasingly severe back pain
• Numbness and tingling down your legs
• Weakness and decreased sensation of the lower extremities
• Loss of bowel and bladder control.
• Hypercalcemia - is known as an elevated blood calcium level. When the level of calcium in the blood is too high, certain problems may occur. Symptoms of hypercalcemia may include:
• Frequent urination.
• Poor appetite.
• Nausea and vomiting
• Constipation.
• Excessive weakness and fatigue.
• Muscle twitching.
• Confusion, or behavior changes.
• If you notice these symptoms, notify your healthcare provider immediately.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.