Prostate cancer with bone metastasis: an overview of pain assessment and management

The challenges of assessing and assisting men with chronic progressive metastatic bone pain secondary to prostate cancer can be immense. All patients have a right to have their pain assessed and relieved by knowledgeable health professionals, yet many urology outpatient clinic nurses come from a surgical background and have limited skills and knowledge in this area. This article aims to enhance the knowledge of urology nurses, by critically analysing and discussing components of current pain management practice, for men with painful bone metastasis. To this end, the pathophysiology of metastatic bone pain is briefly outlined followed by pain definitions from literature and information pertaining to assessment of bone pain. Barriers to effective pain assessment are identified, along with a brief discussion on the impact of factors like fatigue, anxiety and depression on pain. A review is undertaken of selected pharmacological and non-pharmacological strategies for the management of bone pain, as reported in published literature. Knowledge of the WHO analgesic ladder for cancer pain and the actions of pain-relieving medications and their adjuncts will better equip nurses to educate patients regarding their effective use. Insights gained into potentially effective non-pharmacological strategies for the reduction of the experience of pain should prompt nurses to investigate what modalities are on offer at their place of work and within their local community. Written resources can then be created to share this information with patients if they are not already in existence.