narcotics may suppress respiration, which is unwelcome in individuals with lung cancer. The pathophysiological Bicalutamide mechanisms of pain in patients with bone metastases have not been fully elucidated but may include tumour induced osteolysis, production of tumour growth factors and cytokines, nerve infiltration, ion channel stimulation and production of endothelins and nerve growth factors in local tissues . Bone metastases commonly occur at the base of the skull, the vertebral column or pelvic and femoral areas. Metastases at the base of the skull are associated with cranial nerve palsies, neuralgias and headaches, while vertebral metastases produce neck and back pain, with or without neurological complications secondary to epidural extension.
Pelvic and femoral lesions produce pain in the lower back and limbs, often associated with mechanical instability and incident pain. Bone metastases can also result in pathological fractures , which cause pain and have a detrimental effect on QoL . Pathological fractures and spinal cord compression impair mobility and functional independence. Despite the prospect of severe pain Lacosamide 175481-36-4 and reduced QoL, there are few data on patient reported outcomes . In an Italian study of 1021 individuals enrolled in three randomised trials of chemotherapy for NSCLC, QoL , analgesic use and adequacy of pain management were assessed. Bone metastases were present in 22% of patients and were associated with some degree of pain in almost 75% of these cases . Almost 50% of participants reported that pain affected buy Lopinavir their daily activities and the severity of pain was linearly correlated with decreases in QoL scores; mean global QoL decreased from 64.
9 for patients without pain to 36.4 for those with severe pain . The study revealed that 82% purchase Irinotecan of individuals reporting pain received inadequate analgesia. Although analgesics may be used to treat the symptoms of bone pain, they do not address the underlying cause, and side effects of opiates, such as nausea and constipation, may be worse than the pain itself . Therefore, delaying the need to use strong analgesics may be advantageous in patients with lung cancer. A Norwegian study evaluated pain, QoL, depression, physical functioning and social functioning at the time of enrolment into a randomised clinical trial of 157 oncology outpatients with pain from bone metastases .
One aim of the study was to determine which of the following were key predictors of QoL: pain characteristics , psychological distress , physical functioning and social functioning. Another aim was to determine invertebrates the extent to which all of these variables were correlated. The results showed that ‘meaning of pain’ was significantly correlated with all the other variables, particularly pain intensity and duration. The key factors that predicted QoL were depression, social functioning and physical functioning, with depression proving to be the most important of these . cost Cancer related bone disease contributes significantly to health care costs. In 2004, the cost of metastatic bone disease in the USA estimated by the National Institutes of Health was US$12.6 billion or 17% of total oncology expenditure . In this analysis, the estimated number of patients with lung cancer was 237 469, with an estimated metastatic bone disease rate of 15.6%. The increase in expenditure following metastatic bone disease diagnosis was US$36 000 in commercially insured patients with lung cancer when compared with a matched control group.
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