Incident pain and analgesic consumption decrease after samarium infusion: a pilot study.
OBJECTIVE
The aim of this pilot study was to observe the variations of pain intensity on movement and at rest and the variation of analgesic drug consumption in patients with prostate cancer and painful bone metastases treated with a single dose of 1.0 mCi/kg of samarium-153 (153-Sm) lexidronam.


METHODS
Case series.


METHODS
The Nuclear Medicine Unit and Pain Therapy and Palliative Care Unit, National Cancer Institute of Milan, Italy.


METHODS
Thirteen outpatients with hormone refractory prostate cancer and painful multiple bone metastases.


METHODS
Infusion of a single dose of 1.0 mCi/kg of 153-Sm lexidronam, pain therapy, and the assessment of pain intensity at rest and on movement.


METHODS
Variation of pain intensity on movement and at rest by means of a verbal scale and the reduction of analgesic drug consumption 4 weeks after infusion of 153-Sm lexidronam.


RESULTS
From baseline, 61.5% of patients reported a decrease of at least two levels of pain intensity on movement and 53.8% of patients had an improvement of pain at rest. Of the patients, 15.4% were not in pain at rest or on movement at baseline and continued to be free of pain 4 weeks after the administration of samarium. All ten patients, but one, who were on analgesic drugs before samarium infusion, reduced the regular drug administration or rescue medication. Bone marrow toxicity was mild and readily reversible in three patients.


CONCLUSIONS
In patients with bone metastases, pain on movement is a frequent and often difficult clinical problem to treat and the most frequent cause of breakthrough pain. In patients with painful multiple bone metastases due to prostate cancer, the infusion of a single dose of 1.0 mCi/kg of 153-Sm lexidronam may be considered an effective and safe treatment for pain either at rest or during movement.
Ripamonti
Carla
C
Rehabilitation and Palliative Care Operative Unit, National Cancer Institute of Milan, Via Venezian, 1, Milan, Italy. carla.ripamonti@istitutotumori.mi.it
Fagnoni
Elena
E
Campa
Tiziana
T
Seregni
Ettore
E
Maccauro
Marco
M
Bombardieri
Emilio
E
D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001853:Bone Marrow / Q000187:drug effects; D001859:Bone Neoplasms / Q000556:secondary; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009068:Movement; D009942:Organometallic Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D009943:Organophosphorus Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D010865:Pilot Projects; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology; D012146:Rest; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009942:Organometallic Compounds; D009943:Organophosphorus Compounds; C061972:samarium Sm-153 lexidronam; D009020:Morphine