Management of cancer pain with analgetic adjuvant and weak opioid in prostate cancer bone metastases: A case series

Abstract

Background In cancer patients, cancer pain is the most common cancer complication. About 60–90% of patients with advanced stage cancer experience various levels of pain, and about 30% of patients have been suffering from persistent severe pain. Bones are the most frequent targets of metastases in patients with cancer such as breast, prostate, lung, kidney, and thyroid. In advanced prostate cancer, bone metastasis leads to bone pain, skeletal fracture, and increased mortality. At least 75% of patients with bone metastasis experience bone pain. Case description We report three cases of cancer pain, treated with primary cancer from the prostate metastasis to the spine. All three patients had lower back pain that radiated to the left and right limbs, with mixed pain and bone pain, where early hospital admission shows the Numeric Rating Scale (NRS) pain scale 9–10. Treated with administration of adjuvant therapy (Gabapentin) and weak opioids (injections of Tramadol) as well as injections of Metylprednisolone (for 3 days), the patient's pain scale was evaluated, and the average NRS obtained on days 2–4 was 5–6. On day 5–8, treatment continued with Gabapentin and Tramadol injections, and the pain scale (NRS) decreased to 2–3. All patients on the 8-9 th day of treatment also received Biphosphonates to reduce pain, bone damage, fracture risk, and blood calcium levels. Patients can be discharged with an oral Gabapentin prescription only. Conclusion A pain scale (NRS) reduction of >50% is obtained from the initial pain scale in cancer pain patients treated using a combination of adjuvant therapy and weak opioids.

Loneliness and depression levels as risk factors of pain in geriatric prostate cancer patients

“…It has been reported that 60-90% of the patients experience pain in the advanced stage of the disease, and approximately 30% have severe and persistent pain. (17) In men with prostate cancer, there may be pain in joints or bones in cases where the cancer is not treated and metastasizes. (18) On the other hand, in this study, it was seen that 71.1% of the patients had less than five years of diagnosis, the median duration of pain experienced was two years, and 77.1% of them received cancer treatment (Table 2).…”

Calcium Signalling in Breast Cancer Associated Bone Pain

“…In the same context, tumour cells invading the internal bone cavity can act directly on the very distal processes of nociceptive fibres compressing and damaging them resulting in neuropathic pain [134,136]. This theory is supported also from clinical evidence where neuropathic bone pain has been attenuated by the administration of gabapentin which, binding to α2δ1 subunit of VOCCS, disrupts their trafficking to the presynaptic sites [98,99] being approved for treatment of neuropathic pain [138] and effective in reducing pain in CABP [139].…”

Bone Cancer Pain, Mechanism and Treatment

“…Second in line are weak opioids, e.g. codeine, tapentadol or tramadol, in combination with adjuvants, indicating proven analgesic efficacy in bone cancer pain [88]. There are three classical opioid receptors, e.g.…”