Radiotherapy, morphine, and bone pain: a difficult relationship?

When the progression of disease lowers opioid requirement in cancer patients

OBJECTIVE

To describe 2 cases in which an abrupt progression of disease compromising pain pathways and inducing some relief of existing pain or limiting drug delivery to central nervous system.

METHODS

Case reports which a significant decrease of opioid requirement was reported, either systematically and spinally.

RESULTS

The progression of disease produced changes in pain input or limited the effects of opioids given spinally.

DISCUSSION

The data presented suggest that physicians should be aware of the possibility that opioid doses have to be reduced, where presumably specific events related to the progression of disease can change the pain syndrome or reduce the delivery of opioids when using particular routes of administration. This problem needs to be recognized and treated appropriately when it occurs.

Scoring the effect of radiotherapy for painful bone metastases

RATIONALE

The evaluation of the analgesic effects of radiotherapy in painful bone metastases is a matter of controversies due to a lack of appropriate tools to define the outcome. An integration of competences in monitoring the pain response and modifying the opioid treatment according to changes of the clinical condition is mandatory.

PROPOSED METHOD

A meaningful score, used in previous works to monitor the global response to an analgesic intervention in advanced cancer patients, is proposed. A case report, in which opioids are first titrated and then tapered, is described as an example of application of this method.