Because treatment with this agent can compromise marrow reserve and irreversibly lower platelet count, its use is not recommended if future myelosuppressive chemotherapy is under consideration or if significant thrombocytopenia is present. The bisphosphonates drugs, pamidronate and clodronate, inhibit osteoclast activity and have also been demonstrated to relieve malignant bone pain. 167-173 Parenteral administration of pamidronate every two weeks is generally well tolerated, and the risk of symptomatic hypocalcemia is low. There are limited data that support the potential efficacy of a range of adjuvant agents for the management of bladder spasm, tenesmoid pain, and colicky intestinal pain. It is speculated that these effects are mediated by reduction in pancreatic exocrine secretion.
All cancer patients benefit from psychological assessment and support.
Some also will benefit from specific psychological interventions used in the management of pain. Cognitive interventions can help reduce pain-related distress through the modification of thoughts, feelings, and behaviors. These interventions require that patients have the ability to observe their emotional and behavioral responses in a relatively objective manner and identify dysfunctional reactions and interactions. Specific cognitive techniques, including relaxation, distraction, and focusing, may be useful in reducing pain and pain-related distress. 190-192 Behavioral techniques also seek to enhance coping skills.