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Cancer

Chronic Pain-Metal Rod/Radiation

01/20/2010

Question:

My 57 year old father was diagnosed with a cancer mass which is attached to his femur bone. (Spread their from having lung cancer the prior year). They have explained that it can`t be removed because cutting it will cause the cancer to "break off". He`s gone through chemo & radiation a couple times now. He`s also had a metal rod placed in his leg for stabilization. Months after this surgery and treatments, he developed a chronic severe pain in his leg, lower/further down on his leg than where the mass is. Several tests have been conducted, bone cancer biopsy, CT scans, MRI`s, etc. He`s gone through 3 surgeries to make sure there is not an infection. The Dr. states he has "no idea" why he would be in so much pain. Dr. states that the cancer mass should not be causing this much pain and has actually shrunk in size after radiation. Dr. states that metal rod placement shows no reason to cause this pain. Dr. also believes that radiation would not cause this pain. Dr. has suggested a "specialized CT scan". Dr. has suggested a pain mgt. specialist but no real reason why this pain would occur and no answer what could cause such pain. It`s constant 8-10 pain level type pain. Stabbing/throbbing pain. My father is constantly rubbing his leg. Has been put on several pain killers but hates to take them but has too to get through the day. Any suggestions on what it could be or if you feel that the Dr. is missing something, or another test that can be done? His quality of life has really diminished because of this. Thank you.

Answer:

Based on the description, it is difficult to tell what the problem is. The comment about concern for the cancer to break off is odd. This tumor is already metastatic, so I am not sure what that means. That said, if the femur lesion is not causing the pain then it is not your primary concern. It sounds like he has had a fairly thorough work up. Referral to a pain clinic may be helpful. We do not always determine the primary cause of pain. Alternatively, a second opinion may be helpful. Sometimes it just takes a fresh set of eyes to see the forest from the trees. A previously uninvolved physician may be able to look at things a little more objectively.

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Response by:

Patrick J Getty, MD Patrick J Getty, MD
Assistant Professor of Orthopaedics
School of Medicine
Case Western Reserve University