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BONE PAIN PALLIATION: SUPPORTING ROLE OF STAFF DURING THE RADIONUCLIDE TREATMENT East Tallinn Central Hospital, Department of Nuclear Medicine, Tallinn, Estonia GALINA SHAMARINA EVE PALOTU The World – small or big? PAIN • Pain is one of the main factors which is affecting the quality of life • Pain has a complex nature and different factors contribute to the patient’s perception of pain Symptoms of debility Side-effects of therapy Noncancer pathology Cancer SOMATIC SOURCE Loss of social position Bureaucratic bungling Loss of income Loss of role of family Friends who are don’t visit DEPRESSION ANGER Delays in diagnosis Insomnia Sense of helplessness Disfigurement TOTAL PAIN Unavailable doctors Irritability Therapeutic failure ANXIETY Fear of hospital or nursing home Worry about family Fare of death control Spiritual unrest Fear of pain Family finances Loss of dignity and bodily Uncertainty about future Reproduced from A.J.McEwan “ Palliation of bone pain” BONE METASTASES AFFECT QUALITY OF LIFE Pain Pathologic fractures - immobility Hypercalciemia Neurological problems Anxiety Depression BONE SCINTIGRAPHY Normal scan Multiple bone metastases RELIEF OF PAIN - GOAL IN TREATMENT OF BONE METASTASES relieving pain improve patient mobility improve patient function improve quality of life QUALITY OF LIFE - HEALTH-RELATED QUALITY CRITICAL PARAMETERS: 1. Physical functioning 2. Disease- and treatment-related symptoms 3. Psychological/emotional symptoms 4. Social interactions The "Palliative Care Quality of Life Instrument (PQLI)" in terminal cancer patients. Kyriaki Mystakidou, Eleni Tsilika, Vassilios Kouloulias. Health and Quality of Life Outcomes. http://www.hqlo.com/content/2/1/8 THE AIM OF THE STUDY Describe and analyse the aspects of the activities • nuclear medicine staff taking care of patients during the pain palliation with radioisotopes • patients participate in their treatment to get a sense of control over their disease METHODS FOR EVALUATION OF QUALITY OF LIFE Specifically for cancer patients are suitable: Karnofski ja WHO daily diaries questionary Pain descriptor scale PDC Patient’s analgetic use (opioid) Personal’s global assessment PGA Othes aspects of quality of life (patient’s daytime discomfort , quality of sleep etc) DIARY OF PAIN ASSESSMENT Patient assesses daily his/her intensity of pain and completes the diary in 10 point scale - APS According to the APS the efficiency of treatment is evaluated and also to compare the different methods of therapy ASSESSMENT OF PAIN RELIEF USING ANALOGUE PAIN SCALE No pain 0 1 2 3 4 5 6 7 8 Pain relief Changes in APS Complete Substantial Minimal No response 80% and more 30-79% 10-29% 9% and less 9 10 Max pain PERSONAL’S GLOBAL ASSESSMENT 1. Condition is worse, patient feels more pain 2. Condition has not changed 3. Condition slightly better, slight relief of pain 4. Condition is moderatly better, moderate relief of pain and discomfort 5. Condition is much better, marked relief of pain and less discomfort 6. Condition is good, complete relief of pain and no discomfort during the daily performances ANALGETIC USE • Prior the start of treatment all the doses of medications are recorded (24h) • All the doses are converted to morphine equivalents • During the treatment patient records all the doses of medications • Change in opiod analgetic use gives information of the treatment efficacy TREATMENT ROOM CHARACTERISATION OF PATIENT POPULATION 1995-2004 with bone pain due to metastatic breast (MBC) or prostate cancer (MPC) Median Age (y) MPC 66 (40-79) MBC 53 (36-68) Total NSAID 39 (73%) Narcotics 13 (27%) Total 52 22 (75%) 8 ( 25%) 30 61 (74%) 21 (26%) 82 23 Single BM 59 Multiple BM BONE PAIN RESPONSE TO THERAPY 17% Complete Substantial Minimal No 15 43 10 14 (18%) (53%) (12%) (17%) 18% Complete Substantial 12% Minimal No 53% 82 patients Time of response 1 - 2 weeks after treatment Duration of response - 4 - 24 weeks BONE PAIN RESPONSE TO THERAPY 0% 5% 0% 24% Complete 48% 54% 17% Multiple Mts Complete Substantial Minimal No 52% Substantial Minimal No Single Mts 15 3 12 43 32 11 10 10 0 14 14 0 82 59 23 CONCLUSIONS • Treatment with radioisotopes is an effective method for the palliation of metastatic pain providing relief in majority of our patients • As the therapy affects the site of pain without affecting central nervous system the patients really feel the improvement of their QoL CONCLUSIONS • Patients want a voice in their life care, and participation in treatment, this would give them a sense of control over their disease • It is hightly depended of staff management quality YOU CAN’T STOP THE CLOCK, BUT YOU CAN CONTROL THE PAIN