DOCSLIB.ORG

Bone Marrow Transplantation (2000)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bone Marrow Transplantation (2000) Bone Marrow Transplantation (2000) 26, 673–675 2000 Macmillan Publishers Ltd All rights reserved 0268–3369/00 $15.00 www.nature.com/bmt Case report First manifestations of seronegative spondylarthropathy following autologous stem cell transplantation in HLA-B27-positive patients B Koch2, N Kranzho¨fer1, M Pfreundschuh1,2, HW Pees1 and L Tru¨mper1 1Dr Mildred-Scheel Unit for Blood Stem Cell Transplantation and 2Saarland University Rheumatology Center, Department of Internal Medicine I, Saarland University, Homburg, Germany Summary: usually disappear after recovery and restoration of physical fitness and are therefore probably related to immobilization Two male patients with non-Hodgkin’s lymphoma and/or medication such as drugs used in conditioning regi- (NHL, follicular NHL, diffuse large B cell NHL, both mens, steroids or total body irradiation. We describe three in 2nd complete remission) and one female patient with patients who presented with rheumatic symptoms after acute myeloid leukemia in 1st complete remission autologous SCT. These were shown to be primary manifes- developed arthralgias and enthesopathy following auto- tations of an HLA-B27-associated rheumatic disorder. logous stem cell transplantation. In 2/3 patients, sacro- iliitis could be demonstrated on X-ray. In both patients, the rheumatic symptoms were classified as manifes- Case reports tations of a spondylarthropathy. All three patients were subsequently shown to be HLA-B27-positive. The During regular follow-up at our transplant unit, arthralgias patients were successfully treated with non-steroidal were observed in 3/140 consecutive patients following anti-inflammatory drugs. The differential diagnosis of autologous PBSCT. All three were shown to be HLA-B27- joint pain following autologous stem cell transplantation positive. Details of the patients are listed in Table 1. 114 should include HLA-B27-associated spondylarthropath- autologous transplant patients and 26 allogeneic transplant ies in addition to the more commonly seen bone and patients were included in this series. 78 were male and 62 joint pain due to immobilization and medication. Bone female. The median age at transplant was 40 years. The list Marrow Transplantation (2000) 26, 673–675. of diagnoses included NHL (n = 59), ALL (n = 6), AML Keywords: autologous stem cell transplantation; HLA- (n = 20), CML (n = 9), MDS (n = 1), HD (n = 20), multiple B27; spondylarthropathy; enthesopathy; non-Hodgkin’s myeloma (n = 8) and solid tumors (n = 17). 105 patients lymphoma; late effects received peripheral blood stem cells and 35 bone marrow as the stem cell source. The data were retrieved from our data base (Stemsoft, Vancouver, BC, Canada). All trans- plants were registered with the EBMT-G. Joint pain is a common finding in patients after bone mar- row or stem cell transplantation. Following allogeneic bone marrow (BMT) or blood stem cell transplantation (SCT), Case 1 rheumatic manifestations such as arthralgias and arthritis A 39-year-old male with relapsed follicular NHL achieved have been reported previously. These are thought to be due a 2nd complete remission (CR) following treatment with to avascular necrosis of the bone or are interpreted as an two cycles of the Dexa-BEAM regimen (dexamethasone, early clinical sign of imminent chronic graft-versus-host- carmustine, etoposide, cytosine arabinoside, and 1–3 disease, respectively. During the course of chronic graft- melphalan8) and abdominal bath irradiation with 20 Gy. versus-host disease characteristics similar to several auto- The patient underwent conditioning with the BEAM-regi- immune diseases such as scleroderma, Sjo¨gren’s syndrome, men9 and received 2.5 × 106 CD34-positive cells/kg body 3–6 and polymyositis may be seen. In the follow-up of auto- weight. Hematological recovery was uneventful logous SCT autoimmune events such as thyroiditis, throm- (neutrophils Ͼ1000 on day 12, platelets Ͼ20 000 on day bocytopenic purpura, and hemolytic anemia have been 19). Neutropenic fever and slight pulmonary infiltrates in 7 described, and in the early post-transplant period, joint and the second week after transplant resolved with standard bone pain are relatively common events. However, these broad spectrum antibiotics. Serology for common infec- tions and blood cultures was negative. No other infectious complications occured during the first month. After a period Correspondence: Dr L Tru¨mper, Department of Internal Medicine I, Dr Mildred Scheel Unit for Stem Cell Transplantation, Saarland University, of 3 months, he developed arthralgias in the knee-joints and D–66421 Homburg, Germany wrists and heel pain, and 3 months later low back pain and Received 5 November 1999; accepted 20 May 2000 tenderness of the sacroiliac joints. X-rays revealed minimal Spondylarthropathy in HLA-B27-positive patients B Koch et al 674 Table 1 Characterization of patients with rheumatic symptoms fol- of pain in his heels and in his shoulder joints worsened by lowing autologous stem cell transplantation exercise and receives regular medication with NSAID. Case 1 2 3 Case 3 Sex Male Male Female A 29-year-old female was diagnosed with acute myeloid Diagnosis NHL, NHL, DLBC AML, FAB follicular M4 leukemia (FAB M4 subtype) in 1984. After induction ther- Source of stem cells Peripheral Peripheral BM apy with HAM she was transplanted in 1st CR after con- Cond/HD-CT BEAM BEAM TBI/Cy ditioning with total body irradiation and cyclophosphamide. Status at SCT Second CR Second CR First CR In 1985 she acquired an infection with Yersinia enterocoli- Age at SCT (years) 40 39 29 Current hematological status Third relapsea CR CR tica proven by stool culture. A few months later, she Onset of rheumatic +3 months +4 months +1 year developed low back pain, arthralgias in the knee-joints, symptoms after SCT ankles, wrists, heel pain and tenderness of the sacroiliac Enteritic infection −−Yersinia joints. Grade III sacroiliitis and a heel spur on the right enterocolitica were demonstrated by X-ray examination 6 years after Arthralgias +++ Joint swelling −−−onset of the rheumatic symptoms. Bone scans with tech- Low back pain +−+netium 99m showed increased uptake in the knee joints, Enthesopathy +++wrists, ankles, and in the right heel. The patient responded X-ray: sacroiliitisb grade II ND grade III to treatment with NSAID. She is in continuous 1st CR of X-ray: heel spur + ND + (right) Bone scan-technetium 99m heels + ND right heel + the hematological disease 15.5 years following SCT. How- HLA-B27 +++ever, she still needs treatment with NSAIDs to relieve Response to NSAID +++her symptoms. Time from SCT (years) 4.5 4 15.5 Current rheumatic symptoms + (+) + Discussion SCT = stem cell transplantation; cond/HD-CT = conditioning/high dose- chemotherapy; BEAM = carmustine, etoposide, cytosine arabinoside, mel- phalan; TBI/Cy = total body irradiation/high-dose cyclophosphamide; According to the preliminary criteria proposed by the Euro- CR = complete remission; NSAID = non-steroidal antirheumatic drugs; pean Spondylarthropathy Study Group10 the rheumatic ND = not done. symptoms in two of the three patients described here could a At age 43 years. be classified as classical features of a spondylarthropathy. bGrading based on European Spondylarthropathy Study Group prelimi- nary criteria. In the third patient (case 2) the symptoms could be classi- fied as features of an incomplete undifferentiated spondyl- arthropathy fitting into the ARMOR classification of spon- dylarthropathias.11 In all three patients the rheumatic bilateral grade II sacroiliitis and heel spurs 6 months after symptoms evolved in the early post-transplant period. One transplant with bone scintigraphy activity at the heels and of the three patients presented with a pulmonary infiltrate at the wrists. He received non-steroidal-anti-inflammatory during the early post-transplant period (case 1), the second drugs (NSAID). After treatment for 4.5 years he is still patient suffered from an enteritic infection with Yersinia complaining of pain in the knees and heels. A Schober test enterocolitica before the onset of rheumatic symptoms of the lumbar spine revealed a 3 cm increase in distance (case 3), while the third patient did not report any enteritic, after maximal forward bending, and chest expansion was genito-urinary or other infection (case 2). None of the 2 cm compatible with restricted spine flexibility. Continu- patients had experienced symptoms of a rheumatic disease ous treatment with NSAID for symptomatic relief is neces- before the transplant. After autologous PBSCT, develop- sary and recently, treatment with azulfidine had to be ment of a polyarthritis has been described secondary to a started. Four years after PBSCT, the patient’s low grade CMV infection.12 However, in our cases no evidence for NHL relapsed. a CMV infection was found. Whether the immunological changes associated with autologous SCT favor the manifes- Case 2 tation of rheumatic symptoms in HLA-B27-positive indi- viduals is not clear. Since HLA-typing had not been per- A 39-year-old male was diagnosed with relapsed high- formed regularly in our autologous transplant group, the grade non-Hodgkin’s lymphoma (diffuse large B cell lym- incidence of rheumatic symptoms in HLA-B27-positive phoma of the mediastinum according to the REAL patients cannot be judged with certainty. In our patient classification) in 1995. After treatment with two cycles of group, the prevalence of HLA-B27-associated rheumatic Dexa-BEAM, he achieved a 2nd CR and was subsequently disease was 2.1%, which
Load more

Recommended publications
  • Clinical Data Mining Reveals Analgesic Effects of Lapatinib in Cancer Patients
    www.nature.com/scientificreports OPEN Clinical data mining reveals analgesic efects of lapatinib in cancer patients Shuo Zhou1,2, Fang Zheng1,2* & Chang‑Guo Zhan1,2* Microsomal prostaglandin E2 synthase 1 (mPGES‑1) is recognized as a promising target for a next generation of anti‑infammatory drugs that are not expected to have the side efects of currently available anti‑infammatory drugs. Lapatinib, an FDA‑approved drug for cancer treatment, has recently been identifed as an mPGES‑1 inhibitor. But the efcacy of lapatinib as an analgesic remains to be evaluated. In the present clinical data mining (CDM) study, we have collected and analyzed all lapatinib‑related clinical data retrieved from clinicaltrials.gov. Our CDM utilized a meta‑analysis protocol, but the clinical data analyzed were not limited to the primary and secondary outcomes of clinical trials, unlike conventional meta‑analyses. All the pain‑related data were used to determine the numbers and odd ratios (ORs) of various forms of pain in cancer patients with lapatinib treatment. The ORs, 95% confdence intervals, and P values for the diferences in pain were calculated and the heterogeneous data across the trials were evaluated. For all forms of pain analyzed, the patients received lapatinib treatment have a reduced occurrence (OR 0.79; CI 0.70–0.89; P = 0.0002 for the overall efect). According to our CDM results, available clinical data for 12,765 patients enrolled in 20 randomized clinical trials indicate that lapatinib therapy is associated with a signifcant reduction in various forms of pain, including musculoskeletal pain, bone pain, headache, arthralgia, and pain in extremity, in cancer patients.
    [Show full text]
  • Approach to Polyarthritis for the Primary Care Physician
    24 Osteopathic Family Physician (2018) 24 - 31 Osteopathic Family Physician | Volume 10, No. 5 | September / October, 2018 REVIEW ARTICLE Approach to Polyarthritis for the Primary Care Physician Arielle Freilich, DO, PGY2 & Helaine Larsen, DO Good Samaritan Hospital Medical Center, West Islip, New York KEYWORDS: Complaints of joint pain are commonly seen in clinical practice. Primary care physicians are frequently the frst practitioners to work up these complaints. Polyarthritis can be seen in a multitude of diseases. It Polyarthritis can be a challenging diagnostic process. In this article, we review the approach to diagnosing polyarthritis Synovitis joint pain in the primary care setting. Starting with history and physical, we outline the defning characteristics of various causes of arthralgia. We discuss the use of certain laboratory studies including Joint Pain sedimentation rate, antinuclear antibody, and rheumatoid factor. Aspiration of synovial fuid is often required for diagnosis, and we discuss the interpretation of possible results. Primary care physicians can Rheumatic Disease initiate the evaluation of polyarthralgia, and this article outlines a diagnostic approach. Rheumatology INTRODUCTION PATIENT HISTORY Polyarticular joint pain is a common complaint seen Although laboratory studies can shed much light on a possible diagnosis, a in primary care practices. The diferential diagnosis detailed history and physical examination remain crucial in the evaluation is extensive, thus making the diagnostic process of polyarticular symptoms. The vast diferential for polyarticular pain can difcult. A comprehensive history and physical exam be greatly narrowed using a thorough history. can help point towards the more likely etiology of the complaint. The physician must frst ensure that there are no symptoms pointing towards a more serious Emergencies diagnosis, which may require urgent management or During the initial evaluation, the physician must frst exclude any life- referral.
    [Show full text]
  • Pathological Cause of Low Back Pain in a Patient Seen Through Direct Margaret M
    Pathological Cause of Low Back Pain in a Patient Seen through Direct Margaret M. Gebhardt PT, DPT, OCS Access in a Physical Therapy Clinic: A Case Report Staff Physical Therapist, Motion Stability, LLC, and Adjunct Clinical Faculty, Mercer University, Atlanta, GA ABSTRACT cal therapists primarily treat patients that sporadic.9 Deyo and Diehl6 found that the Background and Purpose: A 66-year- fall into the mechanical LBP category, but 4 clinical findings with the highest positive old male presented directly to a physical need to be aware that although infrequent, likelihood ratios for detecting the presence therapy clinic with complaints of low back 7% to 8% of LBP complaints are due to of cancer in LBP were: a previous history of pain (LBP). The purpose of this case report is nonmechanical spinal conditions or visceral cancer, failure to improve with conservative to describe the clinical reasoning that led to disease.5 Malignant neoplasms are the most medical treatment in the past month, an age a medical referral for a patient not respond- common of the nonmechanical spinal con- of at least 50 years or older, and unexplained ing to conservative treatment that ultimately ditions causing LBP, but comprise less than weight loss of more than 4.5 kg in 6 months led to the diagnosis of multiple myeloma. 1% of all total LBP conditions.6 (Table 1).10 In Deyo and Diehl’s6 study, they Methods: Data was collected during the In this era of autonomous practice, analyzed 1975 patients that presented with course of the patient’s treatment in an out- increasing numbers of physical therapists are LBP and found 13 to have cancer.
    [Show full text]
  • The IASP Classification of Chronic Pain for ICD-11: Chronic Cancer-Related
    Narrative Review The IASP classification of chronic pain for ICD-11: chronic cancer-related pain Michael I. Bennetta, Stein Kaasab,c,d, Antonia Barkee, Beatrice Korwisie, Winfried Riefe, Rolf-Detlef Treedef,*, The IASP Taskforce for the Classification of Chronic Pain Abstract 10/27/2019 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3FlQBFFqx6X+GYXBy6C6D13N3BXo5wGkearAMol2nLQo= by https://journals.lww.com/pain from Downloaded Downloaded Worldwide, the prevalence of cancer is rising and so too is the number of patients who survive their cancer for many years thanks to the therapeutic successes of modern oncology. One of the most frequent and disabling symptoms of cancer is pain. In addition to from the pain caused by the cancer, cancer treatment may also lead to chronic pain. Despite its importance, chronic cancer-related pain https://journals.lww.com/pain is not represented in the current International Classification of Diseases (ICD-10). This article describes the new classification of chronic cancer-related pain for ICD-11. Chronic cancer-related pain is defined as chronic pain caused by the primary cancer itself or metastases (chronic cancer pain) or its treatment (chronic postcancer treatment pain). It should be distinguished from pain caused by comorbid disease. Pain management regimens for terminally ill cancer patients have been elaborated by the World Health Organization and other international bodies. An important clinical challenge is the longer term pain management in cancer patients by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3FlQBFFqx6X+GYXBy6C6D13N3BXo5wGkearAMol2nLQo= and cancer survivors, where chronic pain from cancer, its treatment, and unrelated causes may be concurrent. This article describes how a new classification of chronic cancer-related pain in ICD-11 is intended to help develop more individualized management plans for these patients and to stimulate research into these pain syndromes.
    [Show full text]
  • An Unusual Cause of Back Pain in Osteoporosis: Lessons from a Spinal Lesion
    Ann Rheum Dis 1999;58:327–331 327 MASTERCLASS Series editor: John Axford Ann Rheum Dis: first published as 10.1136/ard.58.6.327 on 1 June 1999. Downloaded from An unusual cause of back pain in osteoporosis: lessons from a spinal lesion S Venkatachalam, Elaine Dennison, Madeleine Sampson, Peter Hockey, MIDCawley, Cyrus Cooper Case report A 77 year old woman was admitted with a three month history of worsening back pain, malaise, and anorexia. On direct questioning, she reported that she had suVered from back pain for four years. The thoracolumbar radiograph four years earlier showed T6/7 vertebral collapse, mild scoliosis, and degenerative change of the lumbar spine (fig 1); but other investigations at that time including the eryth- rocyte sedimentation rate (ESR) and protein electophoresis were normal. Bone mineral density then was 0.914 g/cm2 (T score = −2.4) at the lumbar spine, 0.776 g/cm2 (T score = −1.8) at the right femoral neck and 0.738 g/cm2 (T score = −1.7) at the left femoral neck. She was given cyclical etidronate after this vertebral collapse as she had suVered a previous fragility fracture of the left wrist. On admission, she was afebrile, but general examination was remarkable for pallor, dental http://ard.bmj.com/ caries, and cellulitis of the left leg. A pansysto- lic murmur was heard at the cardiac apex on auscultation; there were no other signs of bac- terial endocarditis. She had kyphoscoliosis and there was diVuse tenderness of the thoraco- lumbar spine. Her neurological examination was unremarkable. on September 29, 2021 by guest.
    [Show full text]
  • Pain Management & Palliative Care
    Guidelines on Pain Management & Palliative Care A. Paez Borda (chair), F. Charnay-Sonnek, V. Fonteyne, E.G. Papaioannou © European Association of Urology 2013 TABLE OF CONTENTS PAGE 1. INTRODUCTION 6 1.1 The Guideline 6 1.2 Methodology 6 1.3 Publication history 6 1.4 Acknowledgements 6 1.5 Level of evidence and grade of guideline recommendations* 6 1.6 References 7 2. BACKGROUND 7 2.1 Definition of pain 7 2.2 Pain evaluation and measurement 7 2.2.1 Pain evaluation 7 2.2.2 Assessing pain intensity and quality of life (QoL) 8 2.3 References 9 3. CANCER PAIN MANAGEMENT (GENERAL) 10 3.1 Classification of cancer pain 10 3.2 General principles of cancer pain management 10 3.3 Non-pharmacological therapies 11 3.3.1 Surgery 11 3.3.2 Radionuclides 11 3.3.2.1 Clinical background 11 3.3.2.2 Radiopharmaceuticals 11 3.3.3 Radiotherapy for metastatic bone pain 13 3.3.3.1 Clinical background 13 3.3.3.2 Radiotherapy scheme 13 3.3.3.3 Spinal cord compression 13 3.3.3.4 Pathological fractures 14 3.3.3.5 Side effects 14 3.3.4 Psychological and adjunctive therapy 14 3.3.4.1 Psychological therapies 14 3.3.4.2 Adjunctive therapy 14 3.4 Pharmacotherapy 15 3.4.1 Chemotherapy 15 3.4.2 Bisphosphonates 15 3.4.2.1 Mechanisms of action 15 3.4.2.2 Effects and side effects 15 3.4.3 Denosumab 16 3.4.4 Systemic analgesic pharmacotherapy - the analgesic ladder 16 3.4.4.1 Non-opioid analgesics 17 3.4.4.2 Opioid analgesics 17 3.4.5 Treatment of neuropathic pain 21 3.4.5.1 Antidepressants 21 3.4.5.2 Anticonvulsant medication 21 3.4.5.3 Local analgesics 22 3.4.5.4 NMDA receptor antagonists 22 3.4.5.5 Other drug treatments 23 3.4.5.6 Invasive analgesic techniques 23 3.4.6 Breakthrough cancer pain 24 3.5 Quality of life (QoL) 25 3.6 Conclusions 26 3.7 References 26 4.
    [Show full text]
  • PATIENT FACT SHEET Chronic Recurrent Multifocal Osteomyelitis (CRMO)
    PATIENT FACT SHEET Chronic Recurrent Multifocal Osteomyelitis (CRMO) Chronic recurrent multifocal osteomyelitis (CRMO), or thought to be rare, occurring in about 0.4 out of 100,000 chronic nonbacterial osteomyelitis (CNO), is an auto- people per year. As recognition of CRMO is increasing, it inflammatory disorder that causes bone pain due to appears to be more common than that. In fact, CRMO may inflammation in the bones not caused by infection. be nearly as common as bone infections. The average age CONDITION Chronic recurrent multifocal osteomyelitis (CRMO) can that CRMO starts is 9 to 10 years. More girls are affected take months to years to diagnose. CRMO was previously than boys. DESCRIPTION Bone pain is the most common symptom. There is a genetic component. Some families have more than one usually tenderness at the affected site (it hurts to be person with CRMO. pushed on). The pain can cause the person to avoid using CRMO is monitored by following symptoms and imaging the affected body part. Some people with CRMO can studies. MRI is the best way to assess resolution of active develop arthritis (joint swelling). Fatigue is common during bone lesions and/or detect new lesions. active disease. A small fraction of people with CRMO have SIGNS/ SYMPTOMS Treatment of CRMO depends on how severe it is and zoledronic acid). People taking methotrexate and biologic which bones it affects. Treatment usually starts with medications are at a higher risk of infection and should be NSAID medications (ibuprofen, naproxen, meloxicam), evaluated by a doctor if they develop fever or symptoms but some patients need stronger medicines, including of infection.
    [Show full text]
  • Prostate Cancer and Malignant Bone Pain
    Prostate Cancer and Malignant Bone Pain Prostate cancer is the second most prevalent cancer diagnosis among men worldwide, with an estimated 782,000 new cases in 2007 that will lead to over 253,000 deaths [1]. Diagnosis Most patients worldwide are diagnosed above the age of 65; in developed countries, the mean age of diagnosis is approximately 59 years [7]. Earlier diagnosis is partly due to greater awareness about prostate cancer and increased screening, especially with the use of the prostate-specific antigen (PSA) test. The highest incidence rates are in the United States, while parts of Asia and Africa have the lowest incidence, with a 50-fold difference between the lowest and highest incidence rates. The 5-year survival rates for all stages of prostate cancer vary from 40% to over 90% in developed countries. Men with early-stage or localized prostate cancer have a cure rate ranging from 50% to 85%, depending on certain features of their cancer. Those with low-grade features and comorbidities are considered for active surveillance, while those with more aggressive tumors who are otherwise healthy may choose definitive local treatment. These treatments include prostatectomy (radical retropubic or robotic-assisted prostatectomy), external-beam radiotherapy, and low-dose brachytherapy [5]. Those diagnosed with metastatic disease are usually started on systemic hormonal therapy that leads to medical castration (reduction of testosterone levels) and often causes remission of prostate cancer. Symptoms Patients with early-stage prostate cancer may present with bladder symptoms related to local obstruction of the urinary outflow tract. After primary therapy, patients often report irritable bladder and bowel symptoms, urinary incontinence, and sexual dysfunction.
    [Show full text]
  • Bone Pain in Cancer Patients: Mechanisms and Current Treatment
    International Journal of Molecular Sciences Review Bone Pain in Cancer Patients: Mechanisms and Current Treatment Renata Zaj ˛aczkowska 1,* , Magdalena Kocot-K˛epska 2,* , Wojciech Leppert 3 and Jerzy Wordliczek 1 1 Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, 31-008 Krakow, Poland; [email protected] 2 Department of Pain Research and Treatment, Jagiellonian University Medical College, 31-008 Krakow, Poland 3 Laboratory of Quality of Life Research, Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland; [email protected] * Correspondence: [email protected] (R.Z.); [email protected] (M.K.-K.) Received: 10 October 2019; Accepted: 28 November 2019; Published: 30 November 2019 Abstract: The skeletal system is the third most common site for cancer metastases, surpassed only by the lungs and liver. Many tumors, especially those of the breast, prostate, lungs, and kidneys, have a strong predilection to metastasize to bone, which causes pain, hypercalcemia, pathological skeletal fractures, compression of the spinal cord or other nervous structures, decreased mobility, and increased mortality. Metastatic cancer-induced bone pain (CIBP) is a type of chronic pain with unique and complex pathophysiology characterized by nociceptive and neuropathic components. Its treatment should be multimodal (pharmacological and non-pharmacological), including causal anticancer and symptomatic analgesic treatment to improve quality of life (QoL). The aim of this paper is to discuss the mechanisms involved in the occurrence and persistence of cancer-associated bone pain and to review the treatment methods recommended by experts in clinical practice. The final part of the paper reviews experimental therapeutic methods that are currently being studied and that may improve the efficacy of bone pain treatment in cancer patients in the future.
    [Show full text]
  • Back Pain in a Cancer Patient: a Case Study Lucinda Morris Peter Gorayski Sandra Turner
    CLINICAL Back pain in a cancer patient: a case study Lucinda Morris Peter Gorayski Sandra Turner Answer 1 Keywords therapy, palliative; neoplasm metastasis; radiotherapy General inspection for cachexia, anaemia and gait assessment should be performed, as well as neurological examination of the upper and lower Case limbs. Examine the lower back for bony tenderness. A man aged 78 years presented to his general practitioner with new-onset low back Answer 2 pain. The patient had metastatic prostate The differential diagnoses include: cancer, which was diagnosed 2 years ago, • osteoarthritis and a solitary asymptomatic bone metastasis • musculoskeletal strain in the right pubic bone. To date, he had • osteoporotic crush fracture. been managed with androgen deprivation Given the history, a new bone metastasis should be therapy (goserelin) alone. His performance considered. status was good and his prostate-specific antigen (PSA) level stable. His past medical Answer 3 history included hyperlipidaemia and atrial fibrillation. He was on atorvastatin and Malignant spinal cord compression (MSCC) and cauda warfarin. He had no known allergies, was a equina syndrome should be excluded. Symptoms non-smoker and did not drink alcohol. may include worsening back pain, weakness in the He reported a 6-week history of constant, lower limbs, altered sensation and bladder or bowel burning pain in the lower lumbar region, incontinence. MSCC is an emergency and warrants which was worse at night and was 7/10 in urgent referral to a radiation oncologist within severity on the Numeric Pain Rating Scale. 12–24 hours to prevent irreversible progression to He had no relief with regular paracetamol paraplegia.1 Referral can be made directly to the or ibuprofen.
    [Show full text]
  • Headache in Patients with Paget's Disease of Bones
    Journal of Frailty, Sarcopenia and Falls Mini Review Article Headache in patients with Paget’s Disease of Bones Gerasimos Evangelatos, Alexios Iliopoulos Rheumatology Department, 417 Army Share Found Hospital (NIMTS), Athens, Greece All published work is licensed under Creative Common License CC BY-NC-SA 4.0 (Attribution-NonCommercial-ShareAlike) Abstract Paget’s disease of bone (PDB) is a focal remodeling disorder of unknown origin. Head bones are frequently involved and patients may suffer from deformities and specific symptoms, mainly headache, or neurological deficits, such as deafness. Several pathophysiological entities can give rise to headache in PDB patients. Clinical, laboratory, radiological and scintigraphic findings contribute to distinguish headache related to PDB from other causes of headache. Up to the present, treatment with intravenous zolendronic acid has been reported to improve symptoms of PDB and induce long-standing biochemical and scintigraphic remission. In this review, the main strands of literature about epidemiology, pathophysiology, clinical characteristics and treatment of PDB-related headache are drawn together. Keywords: Denosumab, Headache, Paget’s disease of bones, Zolendronic acid Introduction of mechanical compression or reduced blood flow of neural tissue8. Head involvement of PDB may lead to various Paget’s disease of bone or osteitis deformans affects types of headache, hearing loss, or other cranial nerves 1-2% of people over 55 years, mainly men of white race, deficits, hyperemia of skull and basilar invagination and its 1 with higher prevalence in certain countries . It is still consequences. Headache in PDB patients is characterized debatable in the literature if paramyxoviruses (particularly as severe, mostly occipital, deteriorating when intracranial measles and canine distemper) infection in childhood is the pressure increases, as in the case of coughing9.
    [Show full text]
  • Pain Management Facts
    Pain Management Facts No. 19 in a series providing the latest information for patients, caregivers and healthcare professionals www.LLS.org • Information Specialist: 800.955.4572 Introduction Highlights No matter when you have pain over the course of your l A cancer diagnosis does not mean that you will have disease, it is important to remember that all pain can be pain. However, a number of people with cancer do treated and most pain can be controlled or relieved. have pain at some point. For people with blood cancers (leukemia, lymphoma, myeloma, myelodysplastic syndromes and myeloproliferative l Pain may result from the cancer, from its treatment neoplasms) pain can be related to the cancer itself, to the (for example, bone or nerve pain that can be a side treatment of cancer, or both. Pain can also be caused by effect of certain medications) or other coexisting problems unrelated to cancer. diseases (for example, arthritis). Pain can come and go, or be constant. It can be mild or severe. l Pain varies in its intensity. It may be short-lived Each person’s pain is unique and may change over time. (acute) or continue longer than it should after a You should never accept pain as a normal part of having disease or injury (persistent). cancer. If you (or someone you love) is in pain, tell your healthcare provider right away. Treating pain as soon as it l There are many ways to manage pain effectively; begins or stopping pain before it starts is very important. patients whose pain is not controlled well enough Once pain becomes severe, it can be difficult to treat.
    [Show full text]