USE OF A BISPHOSPHONATE (ETIDRONATE) TO IMPROVE METASTATIC BONE PAIN IN 3 HOSPICE PATIENTS

Objective: This report investigates the association among the bisphosp honate etidronate and relief of metastatic bone pain. Maintaining cogn itive function while providing adequate relief from metastatic bone pa in can be particularly difficult in elderly patients. Design: Case Ser ies. Setting: Rural community dwellings (Carroll County, Maryland) and an urban nursing home (Baltimore, MD). Patients: One patient residing in a skilled nursing facility and two patients from a home hospice pr ogram (Carroll Hospice). Interventions: Administration of 400 mg of et idronate in cases of refractory metastatic bone pain. Main outcome mea sures: Reduction in analgesic dosing, improvement in cognitive functio n, and subjective pain improvement. Results: Three cases are presented in which the use of the bisphosphonate etidronate allowed for a reduc tion in opiate use with improvement in pain control and preservation o f cognitive function. Conclusion: Etidronate and perhaps bisphosphonat es, in general, should be considered in the management of refractory m etastatic bone pain, particularly in the hospice population.