B. In addition to causing severe pain, cancer that has spread to bone to can also make the bones weak and susceptible to fracture. Because of this, treatments that improve bone density (see Osteoporosis and Osteopenia—Loss of Bone Density), may decrease bone pain as well. If you have breast cancer, do not use DHEA without your doctor's approval. In one study of patients with bone metastases from breast or prostate cancer, strontium gluconate (the healthy form—not the radioactive one), 274 mg daily, increased bone re-growth in areas of tumor, and often resulted in patients feeling better and gaining weight.5 I would use the 340-680 mg a day dose discussed in the osteoporosis article.
C. Cancer often triggers muscle/myofascial pain, and treating this (see the SHINE Protocol for how to eliminate fibromyalgia/myofascial pain) can result in more comfort and the patient needing less pain medicine and therefore having fewer side effects. In addition, a study by Dr. Neoh Choo Aun, a wonderful acupuncturist and friend in Taiwan, showed that using acupuncture to treat the trigger points in cancer patients was very beneficial.6
D. In one study of 12 patients with very severe neuropathic, or nerve pain, due to the cancer pushing on major nerve centers, IV magnesium was given. Half the patients received 500 mg and the other half 1,000 mg given over 10 minutes. Aside from producing a mild feeling of warmth at the time of the injection, the IV was well-tolerated. 10 of the 12 patients experienced significant relief that lasted approximately four hours.7 I would give 2 grams of magnesium over 30-60 minutes. Most patients with neuropathic pain will not need this—although it can easily be given if they have an IV in place—if they simply use the medications we discuss in Chapter 8 on neuropathies. For more information, see a summary/overview of how to treat nerve pain.
E. It takes much less medication to prevent pain than to make it go away once it occurs. Because of this, if you have chronic pain, take the medication before you expect the pain to occur, or at the first sign of it coming back, instead of waiting for it to be severe. You'll need less pain medicine and have fewer side effects. If narcotic side effects are problematic, ask your doctor to use the other pain medications we discuss in my book as well so you can find a combination that is more comfortable. In addition, chapter 22 on prescription therapies discusses how to treat many narcotic side effects. Using Fentanyl® patches can be very helpful because they give steady release of pain medication, are powerful, and can be taken even if nausea or confusion is present.
It is never acceptable to leave someone in chronic pain, and given newer options in pain management, almost never necessary. It is OK to ask your physician to consult a physiatrist (a physician pain specialist) if your oncologist is not able to get you pain free.
5 Skoryna, S.C. Canadian Medical Association Journal, 125: 703-712. 1981.
6 Aun, N.C. "Myofascial Pain Syndrome in Cancer Pain Management." Chinese Journal of Pain, 1996; 6: 111-118.
7 Crosby, V., et al. "The safety and efficacy of a single dose of intravenous magnesium sulfate in neuropathic pain poorly responsive to strong opioids analgesics in patients with cancer." Journal of Pain Symptom Management, 19: 2000: 35-39.