Pain Management
In addition to treating the underlying cancer and bone
pathophysiology, the management of pain is an important
aspect of patient care. The World Health Organization guidelines
on cancer pain relief advised clinicians to match the
potency of an analgesic to the patient’s pain intensity.
NSAIDs or other nonopioids are recommended for mild pain.
Because of their anti-inflammatory properties, NSAIDs
have been recommended for the treatment of bone pain. They
are believed to produce analgesia by inhibiting prostaglandin
synthesis by inhibiting cyclooxygenase. Numerous NSAIDs
are on the market, and they differ in dose, analgesic ceiling,
cost, and safety. A trial of various NSAIDs may be warranted
because failure with one NSAID may result in successful treatment
with another (Portenoy, 1993).
NSAIDs have a variety of toxicities, most notably, platelet
dysfunction, risks of gastrointestinal bleeding, and renal failure.
NSAIDs should be used judiciously, especially in elderly
or debilitated patients. Although believed to have an improved
side effect profile related to less gastrointestinal (GI) toxicity,
the new cyclooxygenase-2 inhibitor’s role in treating pain
from bone metastasis has not been established yet