Where does bone pain start with prostate cancer?

Prostate cancer can spread to any area of bone around the body. It most commonly spreads to the spine. Pain in these areas can sometimes make it painful to walk and move around. The pain might remain in only one area, but over time it can spread to several parts of your body.

prostatecanceruk.org - Managing pain in advanced prostate cancer

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If your pain comes back before your next dose is due, let your doctor or nurse know. The dose might need changing. You might find your pain doesn’t go away straight away when you take pain-relieving drugs. This is because they can take a while to be absorbed by the body and start working. All medicines can cause side effects. We describe the most common side effects of pain-relieving drugs below. But you might not get all or any of these. If you do get side effects that won’t settle down, your doctor can change the amount or the type of drugs you take. For more information about side effects, check the patient information leaflet included with your medicines or speak to your doctor or nurse at the hospital, or your GP.

Non-opioid drugs

These are mainly mild pain-relieving drugs. They include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. These types of drugs are available to buy over the counter from a pharmacy. You can use them together with stronger pain-relieving drugs. Always check with a pharmacist or other health professional before taking new drugs, to make sure they’re suitable for you and safe to take with other medication. NSAIDs can help reduce inflammation that may be causing your pain. You should only take NSAIDs regularly if they’ve been prescribed for you. This is because taking them for a long time can cause side effects such as stomach irritation, stomach ulcers, kidney problems, and heart problems. You may not be able to take NSAIDs if you already have problems with your stomach, kidneys or heart. Your doctor or nurse might prescribe medicines to reduce the risk of side effects from NSAIDs. Taking NSAIDs after food will also help to reduce stomach irritation. You should avoid smoking and drinking large amounts of alcohol, as these can increase the risk of stomach ulcers. Your doctor or nurse can give you more information about this.

Opioid drugs

You might need stronger pain-relieving drugs called opioids. These include strong opioids such as morphine and weaker opioids such as codeine and tramadol. You can take opioids in tablet and liquid form. You may be able to take slow-release opioids so that you don’t have to take them so often. If these are not suitable, some opioids such as fentanyl or buprenorphine are also available as a skin patch. If you find it hard to swallow tablets or liquids, your doctor or nurse might suggest a continuous dose of opioids through a needle under the skin. This uses a small machine called a syringe pump or syringe driver. It means the drug stays at a constant level in your body so it does not wear off. Syringe pumps can be used in hospital or in your home. It’s possible to get sudden pain even if you’re already taking pain-relieving drugs. This is called breakthrough pain. If you experience this, your doctor or nurse may suggest a fast-acting opioid to help reduce the pain quickly. Difficulty emptying your bowels (constipation). Most people get this side effect of opioids, which can be very uncomfortable. Your doctor should give you medicines to make it easier to empty your bowels (laxatives). Drinking plenty of water, eating a high fibre diet and exercising, if possible, might also help to prevent constipation. If it does not get better, speak to your doctor – but don’t stop taking the pain-relieving drugs. Sickness. You might feel sick or be sick for the first few days of taking opioids, but this usually improves. If you feel sick, your doctor can prescribe anti-sickness tablets to stop this. Or give you a different pain-relieving drug if the sickness does not improve.

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Drowsiness. When you first start taking opioids you might feel drowsy or find it hard to concentrate. This usually improves after a few days, as your body gets used to the drug. Ask your doctor or nurse whether it is safe for you to drive when you are taking opioids. A dry mouth. Sipping cold water throughout the day can help. You can also try chewing gum or sucking boiled sweets or ice cubes. Some men worry about becoming addicted to stronger opioids such as morphine. But if you’re taking morphine to relieve pain, it’s unlikely you’ll become addicted. You might not start with the strongest type of opioid, and the dose will be carefully controlled by your doctor. If you’re worried, speak to your doctor or nurse.

Other drugs for relieving pain

There are other types of drugs that can also be used to help treat pain. Which ones you are prescribed will depend on what is causing your pain. Your doctor might suggest drugs that can also be used to treat other health problems. For example, drugs that can be used to manage epilepsy (such as gabapentin or pregabalin) or depression (such as amitriptyline) can help with nerve pain. If your doctor prescribes anti-depressants or anti-epileptics for your pain, it does not mean they think you are depressed or have epilepsy. Different doses of these drugs are usually needed to treat depression or epilepsy. A type of cream called capsaicin cream can also be used to help with nerve pain if you find it difficult to take tablets. A pain-numbing skin patch, such as a lidocaine patch, can also be used on painful areas.

Antibiotics can be prescribed if your pain is caused by an infection.

Muscle relaxants (such as diazepam) can also be used if you have muscle spasms. Muscle spasms can be painful or make other pain worse. Talk to your doctor, nurse, or pharmacist about possible side effects before you start taking any new medicines.

Steroids

If your cancer has spread to the bones it could cause swelling and press on the nerves in the bone, causing pain. Steroids can help to reduce swelling around the cancer, and so reduce the pain. You might be able to take steroids in combination with pain-relieving drugs and other types of treatment. Lower doses of steroids can also be used to treat the cancer itself. Like most medicines, steroids can cause side effects. Read more about steroids, including the possible side effects.

Other pain-relieving treatments

Pain-relieving radiotherapy

Pain-relieving radiotherapy can shrink the cancer cells in the bones and stop them pressing on nerves and causing pain. It can also sometimes slow the growth of cancer cells, giving your bones time to repair and strengthen. Radiotherapy can be given externally, where high-energy X-ray beams are directed at the area of pain from outside the body. It can also be given internally, where a small amount of radioactive liquid is injected into your blood. A radiographer usually gives pain-relieving radiotherapy. It is usually only used in men whose pain can’t be controlled with pain-relieving drugs.

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Most men who have pain-relieving radiotherapy find that it helps control their pain. If your pain comes back, you may be able to have more radiotherapy to the same area. This will depend on the dose you've already had and how long ago you had it. Speak to your doctor or nurse about your own situation.

Bisphosphonates

Bisphosphonates, such as zoledronic acid (Zometa®), are drugs that can help strengthen bones that have become weak or thin. Bisphosphonates can strengthen the bones and slow down further bone damage. This can help relieve pain and lower the risk of broken bones and other bone problems. They are sometimes used if other treatments, such as pain-relieving drugs and radiotherapy, are not controlling your pain. You may be offered another drug called denosumab instead of bisphosphonates.

Surgery to support damaged bone

If there is an area of bone that has been badly damaged by cancer, surgery might be an option, although this is not very common. A metal pin or plate can be inserted into the bone under general anaesthetic to strengthen and stabilise the area of affected bone and reduce the risk of it breaking. Or, a type of cement can be used to fill the damaged area. This makes the bone stronger and less painful. You might have radiotherapy after the operation to help prevent the cancer growing back in that area.

Transcutaneous electrical nerve stimulation (TENS)

Some NHS pain clinics and hospitals offer TENS to help manage pain.

You can also buy a TENS machine yourself online or from a pharmacy. TENS uses a machine to send small electrical currents to nerves in your body through pads placed on your skin. Doctors think that the currents may block the pain signals caused by the cancer. Small studies have found that TENS could help some people with bone pain. But we need more research before we can say for certain whether TENS can help. As the TENS machine is small enough to fit in your pocket, it can be carried around with you so you don’t need to stay in hospital.

Nerve block

This is an injection which changes what you feel in a particular part of the body. It can reduce pain in that area. Nerve block is sometimes an option for men who only have pain in one or two areas, and who are not able to have other treatments or are not responding well to other treatments. Nerve blocks are not widely used and are not available in all treatment centres

prostatecanceruk.org - Managing pain in advanced prostate cancer

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