Somatic Pain Flashcards
Define somatic pain.
somatic pain is a subtype of nociceptive pain arising from bone and soft tissue
What is the most common somatic pain syndrome?
Pain related to bone metastases is the most commonly encountered somatic pain syndrome.
What two cancers are most often responsible for malignant bone disease?
Breast and Prostate Cancer. Occurs in 70% of patients.
Name 3 cancers (other than breast and prostate) that also frequently metastasize to bone.
1) Thyroid
2) Lung
3) Kidney
What cancer involves bone diffusely?
Multiple Myeloma
Most people with bone mets will develop skeletal related events (SRE): Name 4 SRE that can occur.
1) Pathological fracture
2) Hypercalcemia
3) Pain
4) Spinal cord compression
How does cancer induced (CIBP) bone pain typically present?
usually manifests as continuous localized, reproducible pain.
What patient descriptor words often describe bone pain?
Name 2.
Aching
Gnawing
Define breakthrough pain (BTP)
BTP: considered a transient exacerbation of pain, occurring spontaneously or related to a trigger, on a background of stable pain.
How do osteolytic lesions appear on x-ray?
On plain radiographs, bone mets may appear as areas of absent density or absent trabecular structure, representing osteolytic lesions
True or False
For bone mets, x-ray sensitivity is significantly lower compared to bone scan.
TRUE
The sensitivity for x-ray compared to bone scan is significantly lower.
Bone scans can be falsely negative in the work up for multiple myeoloma. Why?
Minimal osteoblastic activity.
What role does osteoprotegerin (OPG) play in the bone cycle.
OPG is a decoy receptor for excessive bone resorption.
It is PROTECTIVE against bone loss.
OPG regulates RANK ligand.
OPG is produced by osteoblasts.
CIBP may arise from compromise of mechanical stability of bone.
1) Osteoclasts are responsible for bone ______
2) Osteoblasts are responsible for bone ______
1) Osteoclasts are responsible for bone RESORPTION
2) Osteoblasts are responsible for bone FORMATION
How long do immediate release opioid formulations take to achieve meaningful pain relief?
30-40mins
What receptor activator do osteoblasts normally express?
Osteoblasts normally express the receptor activator factor-kappa B ligand (RANKL),
RANKL binds to what receptor?
The RANK receptor on osteoclast precursors
This promotes maturation and proliferation.
This type of cancer does NOT show up on bone scans.
Multiple myeloma does NOT show any uptake on bone scan.
In multiple myeloma the osteoblastic response to bone destruction is negligible, therefore no uptake by bone scan.
30-70% of normal bone mineral content must be lost before osteolytic vertebral lesions become apparent on ______.
XRAY
1) How does an osteolytic lesion appear on x-ray?
2) How does an osteoblastic lesion appear on x-ray?
1) Areas of absent density or absent trabecular structure.
2) The bone becomes very dense (sclerotic).
What are some non-cancer conditions that could show up on bone scan?
Name 4.
1) osteoarthritis
2) Infection
3) trauma
4) Paget’s disease
These non- cancer conditions would also have abnormal osteoblastic activity.
Bone scan lacks specificity.
Paget’s disease of bone is a chronic disease of the skeleton. Most often affects older people. The dIsease interrupts the bone remodeling process. New bone is made that is abnormally shaped, weak and brittle.
____ has better contrast resolution for visualizing soft tissue and the spinal cord.
MRI.
Name two adverse effects that can occur with NSAIDS.
1) Renal failure
2) Gastrointestinal ulceration
Risk of gastrointestinal toxicity is higher with increased age, previous peptic ulcer disease, comorbidities, use of multiple NSAIDS (including ASAs) and use in combination with corticosteroids.
Regular administration of ____ has been shown to decrease SRE in breast ca and multiple myeloma.
Bisphosphonate
(zoledronic acid, pamidronate)
Bisphosphonates are synthetic analogues of pyrophosphate which bind to bone matrix and cause OSTEOCLAST APOPTOSIS, thereby reducing bone resorption.
