Table 2 Study characteristics and key findings: case studies

Lewin (2012)

To discuss percutaneous cervical cordotomy for non-cancer pain

Gentleman (67) with cancer and RA.

Percutaneous cervical cordotomy gave effective pain relief for last 11 months of life

Persistent, severe, right hip pain limited quality of life (QoL)

Katz et al. (2008)

To describe arthroplasty for MSK pain at EoL

Older woman with metastatic lung cancer & lymphoma. QoL severely limited by hip OA

Surgery successful; complete relief of hip pain. Increased mobility enabling independent living for last year of life

Del Fabbro et al. (2007)

To discuss temporary palliative sedation

Woman (60’s) with lung cancer and limited metastatic disease. Chronic osteoporosis, OA and chronic back pain

Uncontrolled severe pain despite opioid rotation (oral morphine equivalent of 1440mgs in 24 hrs). Temporary palliative sedation used with good effect (Patient able to return home). Long term chronic musculoskeletal pain (+ somatisation, depression and terminal illness) contributed to complex symptom control requirements at EoL.

Intractable lumber pain

Greenstreet (2001)

To discuss concept of total pain

Woman (early 50s) with colon cancer, metastatic lung disease & PE. History of OA and bilateral knee arthroplasty. Significant pain in left knee from chronic osteomyelitis Pain exacerbated by movement

Treatment complex required. Including, high dose morphine sulphate (460mgs SR 12hrly) + Corticosteroids used as adjuvant to reduce inflammation of the knee. + IV antibiotics to promote comfort

Non pharmacological measures included a brace to immobilise knee joint, crutches to reduce weight baring and ensuring leg supported and elevated