The Manual
18 Mar 2015

The Manual: Managing bone pain in advanced prostate cancer

We've recently seen Stan Carter in EastEnders trying to deal with pain caused by his advanced prostate cancer and last night (Tuesday 17 March) it was revealed that the cancer has spread to his spine. If prostate cancer spreads to the bones, it weakens the bone and can cause pain. Here, our Specialist Nurse, Lara Spiby answers your questions about managing bone pain.

Q. Do all men with advanced prostate cancer have
bone pain?

No. If the cancer spreads to the bones it may cause bone pain but the level of pain varies from man to man, and up to a quarter (25 per cent) of men don’t have any pain at all.

The first areas to be affected are likely to be those closest to your prostate, including your pelvic bone, hips, lower spine and upper thighs. Pain in these areas can make it painful to walk and move around. The pain might remain in only one area, but over time it can spread to other parts of your body.

Q. What is bone pain like?

Some men describe bone pain as feeling similar to a toothache but in the bones, or like a dull aching or stabbing. It can get worse with movement and make the bone tender to touch. Every man’s experience of bone pain will be different. The pain may be continuous or it might come and go. How bad it is can also vary and it could depend on where the affected bone is.

If you have any pain in your back, hips or legs tell your doctor or nurse about it as soon as possible.

Q. How is pain assessed?

Your doctor or nurse will ask questions about your pain to try and get as much information as possible. This is important in finding the best treatment for you.

You might find keeping a diary to regularly record your pain helps you describe it to your doctor or nurse. Write down exactly where you feel the pain, how long it lasts and how bad it is. A good way of describing this is to rate it on a scale of zero to ten. Zero is no pain and ten is the worst pain you can imagine. Also make a note of anything that makes it better or worse.

Your doctor or nurse will examine you to see if there are any obvious physical reasons for your pain. This will help them to decide whether you need any further tests, such as blood tests or an X-ray, MRI scan or CT scan.

Q. How is pain treated?

There are different ways to treat pain. What’s best for you depends on a number of things, including what is causing the pain, your general health, how you are feeling emotionally and what sort of things you do in your daily life. Because pain involves all of these things, treating it often means using a few different approaches.

Treatments to control bone pain include pain-relieving drugs, radiotherapy or drugs called bisphosphonates to treat bone pain.

Q. What type of pain-relieving drugs should I take?

There are different kinds of pain-relieving drugs. Your doctor may use a guide called a ‘pain relief ladder’ to decide which drugs will help you. This way, your treatment can be moved up to the next stage if your pain is not controlled by one type of drug. You might be offered a combination of drugs, because they work in different ways.

Your doctor may prescribe mild pain-relieving drugs such as paracetamol or ibuprofen along with stronger pain-relieving drugs such as codeine, tramadol or morphine.

Q. Can you become addicted to morphine?

If you’re taking morphine to relieve pain then addiction is unlikely. You might not start with the strongest type of pain-relieving drugs, and the dose will be carefully controlled by your doctor. If you are worried about taking morphine or opioids such as codeine or tramadol, speak to your doctor or nurse.

Q. How can I manage the side effects of opioids?

Stronger pain-relieving drugs such as codeine, tramadol or morphine can cause side effects such as a dry mouth, feeling or being sick, feeling tired and drowsy, and constipation.

Simple things like chewing gum, sucking boiled sweets or sipping drinks throughout the day can help keep your mouth moist. Other side effects such as sickness and drowsiness usually improve after a few days, when your body has become used to the drug. If you are being sick, tell your doctor or nurse. They may prescribe anti-sickness tablets to stop this.

Constipation is a common side effect of opioids and it can be very uncomfortable. Your doctor should give you medicines to make it easier to go to the toilet (laxatives). Drinking plenty of water, eating a high fibre diet and keeping active might also help prevent constipation. If it doesn’t get better, speak to your doctor – but don’t stop taking your pain-relieving drugs.

Q. How does radiotherapy help manage pain?

Pain-relieving radiotherapy can shrink the cancer cells in the bones and stop them pressing on nerves and causing pain. It can also slow the growth of cancer cells, giving your bones time to repair and strengthen. It is usually very effective in controlling pain in men with advanced prostate cancer. It is only used in men whose pain can’t be controlled with mild pain-relieving drugs.

Q. What other drugs could I use to help manage
bone pain?

Your doctor might prescribe bisphosphonates. These are drugs that can help treat the pain caused by cancer that has spread to the bones. They can bind to damaged areas of bone and help to prevent and slow down further damage. This helps relieve pain and it might also lower the risk of broken bones.

Q. What else can I do to help control my pain?

There are things that might help you feel more comfortable, for example changing your position often can prevent stiffness and may reduce pain. Hot or cold packs and hot water bottles can also help. Doing something you enjoy, such as listening to music or chatting with friends or family can help take your mind off the pain. Taking a relaxed bath or deep breathing can also make you feel more comfortable. As simple as these tips sound, they really can help.

Q. My pain is really getting me down. Who can I talk to about it?

If you’re in pain or your pain relief isn’t working well, tell your doctor or nurse. With the right treatment, pain can usually be relieved or controlled well. As well as medical help to treat your pain, most men find it helps to get some support with the emotional side of things too.

You might find it helps to talk to your doctor or nurse at the hospital or to your district or community nurse. You can also speak to our Specialist Nurses. They can offer emotional support for you and your family and talk through any concerns you’ve got. We can put you in touch with someone living with advanced prostate cancer who knows what you’re going through. You can also join our online community. It’s a place where men can find and offer support. Even if you don’t feel like writing anything, it can help to read the conversations and see that you’re not alone.

To find out more about managing bone pain please call our Specialist Nurses and ask for our Tool Kit fact sheet, Managing pain in advanced prostate cancer.