Background & Aims

Bone cancer is not common. Most frequent symptom is pain and if this is undertreated, there is a risk of acquiring long term pain and decrease quality of life. It occurs predominantly during adolescent reproductive age of 15-19 years old; hence there are cases of bone cancer during pregnancy. Research data on managing pain among pregnancy are few.

Managing bone cancer-related pain during pregnancy puts a dilemma due to risks of adverse effects of pain medications to the growing fetus. This case report discusses a mother diagnose with osteosarcoma during her pregnancy and why managing pain is important on this stage.

Methods

This study is a case report that follows a pregnant patient who is diagnosed with cancer-related pain due to osteosarcoma from the time diagnosis of cancer up to her labor period. The pain management given were discussed and its possible related adverse effects to the born child.

Results

This is a case of a 25-year-old G2P1 22 weeks age of gestation, diagnosed with Histiocytoma Sarcoma of the right pelvis. She is suffering from pelvic pain, characterized as moderate to severe aching, aggravated by walking with no relief with fixed dose combination of Tramadol + Paracetamol. She was admitted for pain management initially with titrating dose of Tramadol via intra-venous patient-controlled analgesia which provided adequate pain relief. On her discharge, pain medications were shifted to maintenance oral Tramadol, rescue medications for incidental/breakthrough pain and adjuvants. Pain is controlled throughout the course of pregnancy. She then delivered a preterm (35 weeks) baby boy APGAR score 9, Ballard score of 35weeks, birth weight of 1,720 grams, and birth length of 39cm via primary low transverse caesarean section under spinal anesthesia due to premature pre-labor rupture of membrane and cord prolapsed. The born child has no congenital malformation nor heart defect.

Conclusions

Bone cancer occurs predominantly in adolescent years and tends to occur during reproductive years, hence we encounter patients with bone cancer at the same time are pregnant. Pain is a frequent symptom of bone cancer and must be addressed as it may develop to long term pain and decrease quality of life if not properly managed.

Following the WHO step ladder in managing pain; and with the warnings from FDA on using pain medications; we use Tramadol to manage the pain.

With judicious dose titration; providing maintenance; rescue doses and adjuvants together with monitoring of the fetus; are better options for these cases.

The event of premature prelabor rupture has not been confirmed in effect of taking the Tramadol because no studies from the literature that it caused such an adverse effect.

By taking Tramadol, this requires judicious monitoring from the medical team to optimize the benefits both the mother and the growing fetus.

References

1. Zarkavelis, George. et al. Bone and Soft Tissue Sarcomas During Pregnancy: A Narrative Review of Literature. Journal of Advanced Research. 2016
2. Jimenes-Andrade, Juan. et al. Bone Cancer Pain. Ann NY Acad Aci. 2010 June.
3. Yazdy, Mahsa. et al. Prescription Opioids in Pregnancy and Birth Outcomes: A Review of the Literature.
4. Bloor, M. et al. Tramadol in pregnancy and lactation. International Journal of Obstetric Anesthesia. October 2001
5. Kallen, Bengt. et al. Use of Tramadol in early pregnancy and congenital malformation risk. Reproductive Toxicology. October 2015
6. Babb, Malaika, et al. Treating Pain during Pregnancy. Canadian Family Physician. January 2010 Vol. 56.

Presenting Author

Alex Zander A. Bondoc

Poster Authors

Alex Zander Bondoc

MD

St. Luke's Medical Center - Quezon City

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Cancer Pain & Palliative Care