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Neuropathic Pain and Bone Pain

Neuropathic Pain

What is it?

Neuropathic pain is defined as pain that results from a disturbance of function or pathologic change in a nerve.  Causes include compression, infiltration, transection, ischemia and metabolic changes. Neuropathic pain can originate from the central or peripheral nervous system.

Neuropathic pain may respond poorly to opioids. Adjuvant analgesics, medications which work to relieve pain indifferent ways from the usual pain medications, may be necessary.   However, opioids remain part of the package of relief for most patients.

Cochrane review: Opioids for neuropathic pain 

How does it feel?

Neuropathic pain takes many different forms. Among the most common ways that people describe it are as a burning pain or as a stabbing or shooting (lancinating) pain. Strange sensations (dysethesia) can also be caused by nerve damage, and these may be described as painful itchiness or an intense feeling of bugs crawling on the skin.

In addition, patients with neuropathic pain may experience pain in response to something that is not normally painful (allodynia), like a simple touch or the feel of clothing on their skin.

Bone Pain

What causes it?

Bone pain is caused by pressing on, fracturing, or invading the bone. It is one of the most common causes of pain in patients with cancer. Bone pain is especially common in cancers of the breast, prostate, and lung when tumors metastasize to bone.

In many cases, bone pain responds poorly to opioids. Nonsteroidal anti-inflammatory drugs (NSAIDs) are particularly effective for relieving bone pain.  NSAIDs block some of the mechanisms through which bone tumors create pain (prostaglandin production).

Cochrane review: NSAIDS or paracetamol, alone or combined with opioids, for cancer pain

Corticosteroids, bisphosphonates, and radiation treatment can also be helpful in managing bone pain.

Fast Fact: Bisphosphonates for Bone Pain
Fast Fact: Radiopharmaceuticals for painful osseous metastases
Fast Fact: Steroids in the Treatment of Bone Pain

How does it feel?

Bony metastasis can cause a variety of painful symptoms. Pain is usually constant, but may often be worse at night, with movement, or when putting weight on the affected bone. People generally describe bone pain as a dull ache or deep intense pain.   Patients may also experience muscle spasms or periods of stabbing pain.

Escalating pain due to metastases should raise concern about an impending pathologic fracture.   Urgent surgical treatment may be indicated, depending on the patient’s clinical condition and the bone in question.

[back] to Objective 8: Understand how to assess patients with opioid resistant pain and what types of medication may be helpful to them.

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