From: BMT Newsletter
November 1996
Issue #36 - Surviving the Transplant Experiencee - the Caregiver's
Perspective
Reprinted by NYSERNet with Permission from BMT Newsletter
"I've been experiencing aches and pains in my bones since I had my bone marrow or stem cell transplant. What's the cause? Can this be treated?" - Many Readers, many diagnoses.
Patrick Stiff, MD, Director of Bone Marrow Transplantation at Loyola University Medical Center in Maywood, IL responds:
Bone pain is a common complaint of patients who have received bone marrow and stem cell transplant. The probable cause varies, depending on the location of the pain and the disease for which the patient was transplanted. The best advice is to not neglect significant pain and keep pressuring your transplant physician until you have a good explanation for why you are experiencing these symptoms.
One of the most common causes of bone pain is avascular necrosis. Patients with avascular necrosis experience pain in the hips, knees or shoulders. It is usually worse when the person is sitting, lying down or immobile for long periods of time. The pain lessens when the patient gets up and starts walking around.
Avascular necrosis is seen primarily in younger patients who have received a lot of corticosteroids, such as Medrol and prednisone. These drugs may have been given during transplant to prevent graft-versus-host disease, or to treat the disease itself prior to transplant. Corticosteroids damage the growth plates in bones, which leads to damage and the ultimate destruction of bone in the surrounding area.
The best way to prevent avascular necrosis is to reduce or stop the use of steroids as quickly as possible after transplant. If bone pain persists after steroids are stopped, it may stabilize or, in some cases, improve over several months or years.
In severe cases, orthopedic surgeons evaluate the patient and sometimes replace hips or shoulders with prosthetic devices. This usually is very effective in controlling pain and allows patients who have severe symptoms to resume more normal activities. X-rays may not be the best way to diagnose this condition and, in fact, are often normal early on. An MRI is often needed for early detection of avascular necrosis.
Osteoporosis is another frequent cause of bone pain post-transplant, especially in older patients and those with multiple myeloma. Bones become weak due to the disease, the use of steroids, lack of dietary calcium, and/or premature menopause. Fractures may occur without apparent cause. Some of the major bones involved are in the spine. Thus, patients may experience a sudden onset of severe back pain that may radiate down into the legs.
The best treatment for osteoporosis is prevention. Several studies have shown that a new drug called Aredia may actually help stabilize bones, and new oral agents such as Fosamax may actually prevent or slow down osteoporosis. Patients should check with their doctor about the feasibility of using these drugs especially in the face of severe osteoporosis.
For young women who have early cessation of menstrual periods, hormone replacement therapy with estrogen may prevent or slow the development of osteoporosis. This therapy may be contra-indicated in patients with breast or ovarian cancer. Patients should consult their oncologist before beginning hormone replacement therapy.
Some allogeneic transplant patients experience short-term, mild, arthritis-like symptoms related to the use of steroids and cyclosporine. We have found that in many patients, ice packs and Benadryl work to relieve the pain.
Patients who have tumor in their bones may also experience pain. Non-steroidal anti-inflammatory agents such as ibuprofen and Naprosyn are usually effective in controlling the pain. These drugs can, however, increase the risk of bleeding or irritation in the stomach, and should only be taken after consulting your physician. For more severe pain, mild narcotics such as acetaminophen with codeine are often effective, and allow patients to resume normal activities.
The electronic version of this document was created by NYSERNet, Inc., as part of the Breast Cancer Information Clearing House.