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Multiple bone metastasis-related incident pain 

Multiple bone metastasis-related incident pain
Chapter:
Multiple bone metastasis-related incident pain
Author(s):

Manohar Sharma

DOI:
10.1093/med/9780199661626.003.0011
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date: 21 July 2019

This chapter focuses on one very complex and difficult to manage cancer pain. Incident pain is the pain brought about by movement and is usually related to pathological facture of long bones. Incident-type pain may also result from spinal metastases leading on to spinal instability. These patients may then be very difficult to nurse, especially if they also have spinal cord compression-related motor weakness. Usually patients have very little pain at rest and the slightest of movements cause very severe pain. Incident pain responds poorly to opioids. Epidural and intrathecal infusions need to include local anaesthetic in an analgesic mixture in a high dose to control pain, but this can cause numbness and other side effects related to sympathetic blocking actions of local anaesthetics on the spinal cord. Incident pain responds well to treatment directed at treating the cause of pain, e.g. surgical fixation of long bone pathological fractures, spinal fixation if there is spinal instability, or cordotomy if the pain is focal and unilateral.

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