In achieving my aim I will identify and describe the transmission, transduction andmodulation of bone cancer pain, and discuss the factors influencing total pain (physiological,psychological, spiritual and social) and the importance of treating these elements alongsidethe physical symptoms. The pharmacological management of pain and the use of radiotherapy in the management of bone cancer pain will also be addressed.For this learning contract, I utilised various different peer reviewed journal articles that havebeen accessed through the databases CINHAL and EMBASE. I made use of recommendedreading list which contains some very important sources of information. I also accessed
current book publications and reliable, national websites such as “World HealthOrganisation” and the “National Cancer Institute”.
I also accessed resources available to mewhilst on placement i.e. The Clinical Nurse Specialist Pain management and proved to be aninvaluable resource, providing me with some interesting and relevant articles and speaking tome in detail about pharmaceutical agents available and the working mechanisms for these.The Palliative care Clinical Nurse Specialist, was also very helpful and assisted me indeveloping an understanding of when these certain drugs are appropriate. For exampleparacetamol should not be used when the patient is receiving chemotherapy due to fact thatthis type of analgesia masks a temperature which may be a sign the patient is developingneutropenia. She also spoke in detail of the debate about the use of bisphosphonates. Duringone of our reflective practice sessions, we received a talk on care of the dying patient fromanother palliative care nurse. This talk highlighted some very important points in relation tocare of the cancer patient and the total concept of pain and how this affects patients.
Evidence of accomplishment
As cancer advances, it invades and destroys health tissue which in turn causes inflammation,infection, expansion within enclosed areas and oedema (Ferrell 2008). These initiate thereceptors that transmit the pain signals. Due to metastatic spread, several organs arefrequently involved in advanced cancer (Callin et al 2008) therefore pain reported is notlimited to somatic or visceral or neuropathic or nociceptive but may incorporate elements of all four (Bond and Simpson 2002).
Cancer induced bone pain is considered extremely painful due to the fact the bone contains avast number of nociceptive sensory nerve fibres described as C fibres (Raphael et al 2008)These fibres become destroyed by the invading metastatic cells (Callin and Bennett 2008).The C fibres are responsible for the transmission of dull aching pain (Callin and Bennett2008)
. The pain associated with bone cancer has been described as “deep gnawing pain”(Axford and O’ Callaghan 2004) and dull throbbing pain that progressively worsens (Mantyh
2006). The C fibres are unmyelinated so therefore conduct pain in a slow manner incomparison to the A delta fibres which are involved in the transmission of sharp pain e.g.