A simple and effective daily pain management method for patients receiving radiation therapy for painful bone metastases

Abstract

Purpose: The incidence of painful bone metastases increases with longer survival times. Although external beam radiation therapy (EBRT) is an effective palliative treatment, it often requires several days from the start of treatment to produce a measurable reduction in pain scores and a qualitative amelioration of patient pain levels. Meanwhile, the use of analgesics remains the best approach early on in the treatment course. We investigated the role of radiation therapists as key personnel for collecting daily pain scores to supplement assessments by physician and oncology nursing staff and manage pain more effectively during radiation treatment.

Methods and materials: Daily pain scores were obtained by the radiation therapists for 89 patients undertaking a total of 124 courses of EBRT for bone metastases and compared with pretreatment pain scores. The majority of patients (71%) were treated to 30 Gy (range, 20-37.5) in 10 fractions (range, 8-15 fractions).

Results: One hundred nineteen treatment courses (96%) were completed. Pain scores declined rapidly to 37.5%, 50%, and 75% of the pretreatment levels by Days 2, 4, and 10, respectively. Pain was improved in 91% of patients with only 4% of worse pain at the end of treatment. Improved pain scores were maintained in 83% of patients at 1-month follow-up, but in 35% of them, the pain was worse than at the end of treatment.

Conclusions: Collection of daily pain scores by radiation therapists was associated with an effective reduction in pain scores early on during EBRT of painful osseous metastases.

Figure 1. Pain collection form

Figure 2. Pain score obtained during and after RT

RTD1–15=radiation treatment days 1–15 and 1 month follow up; (n)= number of pain score for each treatment time, and at 1 month follow up.

Figure 3. Pain relief observed during and after RT

RTD1–15=radiation treatment days 1–15; (n)= number of treatments evaluated for each time fraction, and at one month follow up

Figure 4. Percentage of patients that observed a pain relief of at least 20% during and after treatment

(n) = percent of patients that had pain reduced =20%, pre-RT= pre radiotherapy treatment, RT D2–8= radiation treatment days 2–8, RT=10 = radiation treatment days 10–15, and at one month follow up.