Don’t be ridiculous there are definite limits and for many they become evident in the aging body. Feel let down by your aches and pains? YEP! You eat right, exercise, don’t smoke, get your routine screenings (see how I left out avoid alcohol?) and yet this beautiful skeleton has total power. Bones are just the hanger for muscles attached by ligaments, but they need some TLC as we age.
Today I want to talk about bone pain – quite ubiqitous in cancer scenerio but relevent to all of us at some point. While there is power in positive thinking (“If you don’t mind- it don’t matter”) the reality brings us up short abruptly too often. Today I type standing because a light jog yesterday sent a shock which would have brought me to my knees, but I couldn’t bend them! Since pain is on my mind, I thought I would share some thoughts for those of you dealing as well.
Joints (not marijuana) while they let us down as we age (present company included) over- use wear and tear not cancer is usually the culprit. Right out of the gate, I am a big fan of mri’s. The number one reason patients seek a doc is due to pain. ASK for the MRI. You have insurance so there is no reason to limit to an xray to cut costs. Mri can show soft tissue around the joint best. It’s critical to know what you are going to treat, so this is a diagnostic step.
Shoulders- rule out rotator cuff tear. Frozen shoulders can occur after breast surgery and radiation and require physical therapy. Elbows, tendinitis- not just from tennis or pickleball even computer use. Hips- osteoarthritis, but with cancer, a place for mets to grow in the femur and the acetabulum (cup). Knees- ouch! usually not cancer. Loss of cartilage is a big issue. Unfortunate for us there is some data that steroid shots and ibuprophen can actually make it worse! Gel shots are ok to temporize but knee and partial knee replacements have come long way and with quicker recovery- definately see an orthopod. Lots of people complain about IT band pain which may actually be originating in the knee. This lateral knee pain can now be treated by geniculate nerve blocks or radiofrequency ablation to stop nerves from “firing”.
Not joints: rib pain, mid femur or arm pain in cancer can signify metastatic bone disease. Pet scans and bone scans are best to diagnose diffuse disease. For prostate cancer there are IV radiopharmceutical infusions which work on the diffuse pain. Most of my patients with bone lesions from any cancer including breast, prostate and lung, are on bisphosphonate injections every 1-3 months which help with pain and bone strengthening, if taken with calcium and vit D. Of course ice (and alot of it all the time), kenetic tape can help as well as brace supports and acupuncture.
Pain meds: opiods work in the brain to reduce sensation, doing little for the actual site of pain and so when Mary complained about morphine and a fentanyl patch this week I placed her on steroid which worked quickly. Gabapentin is a non- narcotic choice as well. Felix was upset about being sent to pain management. “Doc just give me the drugs I don’t want another co -pay”. But for his spinal pain, a local injection and a kyphoplasty to rebuild the collapsed spine worked quickly. These specialists are usually anesthesiologists. If your pain isn’t being managed to your satisfaction, be sure to request a referral to them- they have tools and skills the oncologists do not. A patient called last weekend for pain meds. I asked if he had steroids at home. The next day he was markedly better, able to move around without the narcotics as the inflammation quickly reduced. I am a fan of patients, especially those with cancer, having that crutch available to them. Steroids (prednisone and dexamethasone) do have risks of diabetes, hip flexor weakness, aggressive behavior with psychosis, increased infection, so not a long term solution, but quick non- narcotic fix is perfect.
Always request PT after an injury. Building muscle around joints is key to protecting them and getting you back to full function. Hydrotherapy, swimming, stretching and returning to non high -impact activity is key to overall wellness.
Yes, pain is a pain and effects everything we do, so mitigating it is worth the time, attention, effort, meds and referrals. Don’t think that a script for narcotics is your answer- it rarely is a good one. Push for the help you need and stay strong in mind and the body will follow.