Arthralgia/Myalgia
Widespread joint or muscle pain commonly associated with taxane chemotherapy, vinca alkaloids, aromatase inhibitors and after G-CSF injections.
Questions
- Where is the pain? (Ask if any focal pain, particularly any spinal pain)
- How long have you had the pain? Does anything make it better/worse?
- Has the patient received any treatment that causes joint/muscle ache?
- What medications are you taking for the pain if any?
- Are you taking any blood thinner drug or steroids?
Grade 1 (Green)
Mild pain and not impacting function
Advice
- Ensure not neutropenic
- Reassure regarding side effects
- Monitor temperature
- Review analgesia (use paracetamol and NSAIDs with caution as may mask a temperature)
- Phone/review patient after 24 hours to ensure settling
Grade 2 (Amber)
Moderate pain some impact on function but continuing with ADLs
Advice
- Ensure not neutropenic
- Reassure regarding side effects
- Monitor temperature
- Review analgesia (use paracetamol and NSAIDs with caution as may mask a temperature)
- Phone/review patient after 24 hours to ensure settling
Grade 3 (Red)
Severe pain impacting ADLs
Advice
As per Grade 1 & 2
- Analgesia review: consider tramadol, gabapentin and NSAIDs
- Monitor temperature closely
- Phone/review patient after 24 hours to ensure settling
Grade 4 (Red)
Disabling
Advice
- Arrange admission
- Ensure not neutropenic
- Analgesia review: consider tramadol, gabapentin and NSAIDs
- Monitor temperature closely
- Consider steroids
- Seek specialist advice, i.e.. Palliative care team/Pain team, to assist with management
Handover management with patient’s team, discuss all interruptions of treatment with team +/- AOS prior to proceeding.
Arrange follow up review as necessary.
Initial assessment – patient seen in AOCU
- History of complaint
- Drug history; Note if on Taxanaes/Vinca Alkoloids /Aromatase inhibitors or G-CSF.
- Full set of Vital signs
- Pain Score
- Bloods- FBC and U&Es
- Assess for any signs of systemic infection. Muscle aches may be a sign of infection
- Consider MSCC if patient has bone metastases and c/o back/leg pain +/- associated symptoms of MSCC
Treatments
Analgesics:
- Paracetamol
- NSAIs if no contra-indication
- Consider codeine + paracetamol or tramadol
- Involve palliative care team for severe pain management if disabling and pain severe to require admission
Refer to treating team for discussion of eventual dose reduction.
