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Palliative cancer care - pain - Management
How should I manage bone pain?
- Consider whether there is a treatable underlying cause and discuss with an oncologist if this is suspected (for example, regarding radiotherapy for bone metastases).
- Seek urgent advice from an orthopaedic surgeon if there is evidence or suspicion of an actual or imminent fracture.
- For symptomatic relief:
- If pain is difficult to manage, seek advice from a specialist (such as a palliative care specialist or an anaesthetist with an interest in chronic pain).
Basis for recommendation
- This recommendation is based on palliative care pain management guidelines [Cancer Care Alliance, 2006b; NHS Quality Improvement Scotland, 2004; NHS Argyll & Clyde, 2005; NHS Fife, 2006b; Pan-Glasgow Palliative Care Algorithm Group, 2007a], a chapter from the ABC of palliative care [Colvin et al, 2006], and a textbook on symptom management in advanced cancer [Twycross and Wilcock, 2001].
- CKS recommends seeking specialist advice if pain is difficult to manage because various additional treatments are available in secondary care, including radiotherapy, a bisphosphonate, or nerve block.
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