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Palliative cancer care - pain - Management
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When should I suspect spinal cord compression?

Suspected spinal cord compression is a medical emergency. In order to preserve physical function, it must be diagnosed and treated before there is significant neurological compromise.

  • Suspect spinal metastases if any of the following features are present:
    • Pain in the middle (thoracic) or upper (cervical) spine.
    • Progressive lower (lumbar) spinal pain.
    • Severe unremitting lower spinal pain.
    • Spinal pain aggravated by straining (for example, when passing stool or when coughing or sneezing).
    • Localized spinal tenderness.
    • Nocturnal spinal pain preventing sleep.
  • Suspect spinal cord compression if any of the following features are present:
    • Neurological symptoms (including radicular pain, any limb weakness, difficulty in walking, sensory loss, or bladder or bowel dysfunction).
    • Neurological signs of spinal cord or cauda equina compression.

In depth

How should I manage spinal cord compression?

  • If spinal metastases are thought to be the cause of the pain, seek urgent (within 24 hours) specialist advice from a metastatic spinal cord compression coordinator if available, or alternatively the person's palliative care consultant or oncologist.
  • If there are associated neurological features suggestive of spinal cord compression, seek immediate specialist advice.
  • Unless contraindicated (including a significant suspicion of lymphoma), offer all people with metastatic spinal cord compression a loading dose of 16 mg of dexamethasone as soon as possible after assessment.

In depth

Prescriptions

Dexamethasone (oral)

Age from 16 years onwards
Dexamethasone tablets: 16mg each morning
Dexamethasone 2mg tablets
Take eight tablets each morning (as a single dose)
Supply 56 tablets.
Age: from 16 years onwards
NHS cost: £7.39
Licensed use: yes
Patient information: If you cannot take eight tablets in one go because of nausea, take four tablets each morning and take four tablets each lunchtime.

© NHS Institute for Innovation and Improvement