Bone cancer pain: causes, consequences, and therapeutic opportunities

Pain management is one of the most difficult issues that bone cancer patients face. This is related to the interruption of normal bone cell activity, which is supposed to keep bones strong without growing excessively bulky in bone cancer. Because of the interruption in bone cell function, a bone can become either excessively brittle or overly thick and overdeveloped. Each of these scenarios can cause excruciating pain by stimulating neurons within the bone or stretching the membrane that covers the bone membrane. P. Mantyh (2013). Bone cancer pain: causes, consequences, and therapeutic opportunities. PAIN®, 154, S54-S62.


Cancer itself can be the main cause of pain. This is by growing into or destroying tissue near the affected area. It can come primarily from where cancer started or from other areas where it has spread to. Falk, S., & Dickenson, A. H. (2014). Pain and nociception: mechanisms of cancer-induced bone pain. Journal of Clinical Oncology, 32(16), 1647-1654. As the tumor grows it exerts pressure on nerves, bones and other organs thus causing the pain. Pain may not just be from the physical effect of cancer on the bones but also due to chemicals that cancer releases in the region of the tumor. Treatment of cancer can help the pain in these situations to at least subside.


Treatments related to cancer such as chemotherapy, radiation or surgery can be another potential source of cancer pain. Surgery can be painful, and it may take the time to recover. Radiation may leave behind a burning sensation or painful scars. And chemotherapy can cause many potentially painful side effects, including mouth sores, diarrhea, and nerve damage.


It is recommended that patients suffering from pain caused by cancer be given pain management medication to at least offer relief solutions to the patient. Doctors prescribe opioid pain relief drugs but this medication is proving to be less efficient to patients and hence the need to use a stronger pain killer. Medical marijuana is a better pain killer a stronger dose than the normal painkillers and thus a more effective drug. I recommend that most if not all bone cancer patients have a medical marijuana prescription.


Adapting new knowledge to the local context (Who should you be making this recommendation to and why)?


With the recent research done I recommend health practitioners those especially dealing with bone cancer patients, who include doctors, chemotherapists, radiologists and other practitioners that may be handling bone cancer patients. Kondrad, E., & Reid, A. (2013). Colorado family physicians' attitudes toward medical marijuana. The Journal of the American Board of Family Medicine, 26(1), 52-60. They are the ones that truly understand their patients and their needs as well.


Health givers of these cancer patients can make the best decisions based on how much medical marijuana a patient is supposed to use in a day and how to control harmful side effects associated with the use of this drug.


Assessing barriers to using (what and who would be possible barriers to the translation of your recommendation(s)?)


Some of the barriers facing translation of the medical marijuana are fear. Most doctors are afraid of prescribing medical marijuana top their patients because they fear jail time since not all doctors are licensed to prescribe the drug. Lack of enough studies to show long-term effects of the use of the marijuana on the patient is another barrier to the free prescription of the drug. Studies haven't been completed yet showing what happens to a person after prolonged use of cannabis after cancer survival.


They are hesitant because they do not know if the implications are good or bad. The legislation is also another challenge since not all states have the approval to prescribe from the state officials. This thus limits the usage of medical marijuana in most states. Prolonged use of cannabis brings about addiction and so it is not advised for patients to continually use cannabis. This addiction is the reason why it is not advised for patients to take it for long.


Selecting interventions to promote the knowledge (how would you overcome the barriers, how would you promote the recommendation?)


Some interventions that would help promote the use of medical marijuana in more if not all states are to do extensive research on the implications it has on the overall health of cancer patients, both during sickness and after overcoming cancer. That way most doctors wouldn't be scared of endangering the lives of their patients.


The government should pass laws that support the use of the drugs but under strict supervision so as to at least ease the pain of cancer patients with prolonged pain. O'Keefe, K. (2013). State medical marijuana implementation and federal policy. J. Health Care L. & Pol'y, 16, 39 .Continued researches on the types of cannabis and the roles they play in cancer cells would help promote the use of the drugs comfortably.


Monitoring its use (how will you propose monitoring the recommendation? Who will do the monitoring?)


Sample groups of patients suffering the disease and are willing to use the drugs as a trial can be closely monitored by researchers to determine how the drugs affect cancer and the patient's bodies at large. Also studying patients who are currently on medical marijuana prescription for years and doing follow ups on the quality of their lives since the start of using the cannabis as an alternative to the prescription drugs given by doctors.


Doctors should also sell regulate dosage for the patients that is instead of the patients self-medicating, a certain dosage should be administered just like giving pills of normal drugs. Studying and comparing patients who used cannabis against those who used prescription drugs and especially during chemotherapy periods of cancer treatment. This way one can actually know how each type of drug affects the individual both health wise and in their normal day to day activities.


Evaluating the outcomes (how will you monitor the outcomes for the change?)


Outcomes will be evaluated through data analysis and compilation; both qualitative and quantitative data will be used. Pictorial and graph representations will be used to show the effects of the use of marijuana compared to the use of prescription drugs. Koppel, B. S., Brust, J. C., Fife, T., Bronstein, J., Youssof, S., Gronseth, G., & Gloss, D. (2014). Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 82(17), 1556-1563. Bar graphs will also be used to show the % of pain felt by patients who use prescription drugs against those who used marijuana during chemotherapy treatment and normal times during this trial period. Thereafter a detailed report will be written down to explain the changes observed during the trial period.


Ensuring sustainability in practice (how would you promote this change outside of your initial recommendation?)


Prescription of medical marijuana can be promoted through community mobilization on its importance on pain management, come up with more efficient forms of marijuana that can be used by patients easily instead of those associated with smoking. Advising the legislation to grant hospitals dealing with terminal cases permission to prescribe and administer medical marijuana as a form of painkiller for those patients with severe pain.


References


Bone cancer pain: causes, consequences, and therapeutic opportunities. PAIN®, 154, S54-S62.pain. Journal of Clinical Oncology, 32(16), 1647-1654.


Falk, S., & Dickenson, A. H. (2014). Pain and nociception: mechanisms of cancer-induced bone Mantyh, P. (2013).


Kondrad, E., & Reid, A. (2013). Colorado family physicians' attitudes toward medical marijuana. The Journal of the American Board of Family Medicine, 26(1), 52-60


Koppel, B. S., Brust, J. C., Fife, T., Bronstein, J., Youssof, S., Gronseth, G., & Gloss, D. (2014). Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 82(17), 1556-1563


O'Keefe, K. (2013). State medical marijuana implementation and federal policy. J. Health Care L. & Pol'y, 16, 39

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