What to do about compression fracture. - 1247899

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brigitte
What to do about compression fracture. - 1247899

Dad finshed 4 cycles of alimta/cisplatin 5 weeks ago. More than 2 weeks ago started having a little back pain. Since about 2 weeks ago pain is severe.

On the scan taken about 2 weeks ago it shows a T10 anterior wedge compression fracture but no discussion took place about this. A week ago went to GP and Dad was given My-paid forte (Ibuprofen 400 mg Paracetamol 325 mg) which seemed to give pain relief for up to 6 hours. Finished a box of this and GP suggested Dad see the oncologist. Went to oncologist and after examination and looking at scan again was told that there seems to cancer in the spine too.

He is now going to have radiation to the spine and also to the suspected lung primary which has increased in size during the 4 chemos. Oncologist put Dad on Tramacert which does not help at all for the pain, but Dad is too afraid to take mypaid forte because oncologist said it causes constipation and Dad has been struggling with this having to take Pico prep twice now in 2 weeks. AFter pico prep stomach works, then nothing again.

Have read Dr Wests posts on bone metastasis http://cancergrace.org/lung/2007/02/17/bone-metastases-in-lung-cancer-an... and http://cancergrace.org/lung/category/lung-cancer/general-lung-cancer-iss...

Sorry for being so long winded, but thought you might need some background. At some point would Dad need to have the fracture repaired? The oncologist did not say it must be repaired, but that surgery is an option. After radiation even if it should help with the pain what happens subsequently with the fracture?
Dad is still driving on his own despite the pain. Is this normal and ok?
Am starting to feel very afraid for him. Since first cancer there has been spread to adrenal gland and solid mass in opposite kidney. Now in spine as well. :(

JimC
Reply To: What to do about compression fracture.

Hi Brigitte,

I'm sorry to hear about the pain your Dad has been experiencing. As you know from reading Dr. West's posts about bone mets, you know that they are treated to reduce symptoms. So hopefully the radiation will reduce his pain. When my wife had spine mets and some evidence of compression fracture, radiation successfully reduced her pain. No surgery was performed however, since it was not felt that the fracture would lead to further problems. If your Dad's doctors feel that the compression fracture is not likely to cause additional symptoms, they probably would not recommend further treatment such as surgery.

You may want to read Dr. West's post on surgery for bone metastases: http://cancergrace.org/lung/2007/02/21/surgery-for-bone-metastases-when-...

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
Reply To: What to do about compression fracture.

Jim has provided good thoughts here, as well as the link to surgery that I think is potentially relevant. Surgery or an invasive procedure like vertebroplasty or kyphoplasty are possibilities but not invariably done. Radiation is often the first intervention and is often effective in reducing/controlling pain.

As for driving, It really depends on if he's on medications that can cloud his mental status (generally opioids). If not, there's nothing inherently about a bone metastasis to the spine that should preclude him from driving. Otherwise, the only other thing I'd say is that it's generally possible to escalate the bowel care so that it's possible to take opioids if they're necessary for pain control.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

brigitte
Reply To: What to do about compression fracture.

Hi Jim, Dr West,

So even with a compression fracture as long as pain is relieved he can carry on with the fracture. My concern was that without treatment the fracture would not heal.

Dr West the opoids are not controlling pain, but mypaid forte was. Is this unusal as the tramacert it stronger than mypaid. My concern about driving with a compression fracture was more about a safety issue for himself on others on the road, but this does not seem to be the case, so am relieved.

Its unbearable to see a man who has never had a headache in his life suffer with his back pain. Every few steps he has to stop and bend over to relieve the pain.

Thank you both for your comments, am now hoping that the radiation will relieve his pain.

Brigitte

catdander
Reply To: What to do about compression fracture.

From a quick look I don't think either one of those drugs are as strong as opiates like oxycodone. Perhaps you can speak to a nurse involved to see where he stands on getting drugs to better handle the new pain.

brigitte
Reply To: What to do about compression fracture.

Will do so as pain is definitely not controlled on the tramacert.

Brigitte

Dr West
Reply To: What to do about compression fracture.

I agree that it sounds like an opioid analgesic might be what he needs to control the pain.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education