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Understanding pain management for mCRPC

User
Posted 08 May 2026 at 12:12

Hoping to gather views and provide information in one place for others if they are unfortunate to reach this stage.  OH is now metastatic castrate resistant prostate cancer last PSA was 70.  He has had spinal cord compression treated with radiotherapy to the thoracic spine around T4 and an insufficiency fracture on L5.  He has no more treatment options.  We don’t go back to oncology clinic until end of June which seems ages away and pain management has been passed back to his GP.  We only have telephone conversations with the GP, which seems a bit limited to me as they cannot see how poorly he is but maybe that is the way things are.  GP has been very responsive and available by telephone calls but for once I am feeling a bit confused over the pain management plan and how best to support.  I don’t really understand where the pain is coming from, bone mets, spinal fracture or disease progression. 

Medication currently is Decapeptyl injection every 6 months although I wonder if this is still needed considering where we are.  Paracetamol 500mg x 2 four times a day, Codeine 30mg x 2 three times a day with slow-release Morphine 2 x 10mg at night, Oramorph liquid morphine 10mg/5ml for breakthrough pain and we have just been prescribed Oxeltra – Oxycodone 5mg slow release because the pain has increased to quite unbearable levels at times.  I had asked GP if we needed to be referred to palliative teams for pain control, but she mentioned only when she is unable to control the pain. It just seems that we aren’t where we need to be with reduction in pain, OH has no quality of life and can barely eat.  The side effects from medication also need to be handled as the gut mobility stops and laxatives are needed daily.  So feeling a bit lost and wondering if there is anything else I need to consider to help this situation.

Take care all and thanks for the wonderful support form this online community

User
Posted 09 May 2026 at 12:12
Thank you ColwickChris and Wedidntwantthis. All very helpful suggestions which I will follow up. I have also been looking into how some people don’t respond well for pain reduction to Morphine, especially for neuropathic pain which may be what OH has from his insufficiency fracture. I will research more so we are well prepared for our next conversations with the GP and others and keep this post up to date as we progress because I am sure it will help others. We are only 3.5 years into PC and I am surprised to be at this dreadful stage so soon.

Thanks

User
Posted 08 May 2026 at 22:10

Schubert, sorry I don't have any answers or advice to offer, but wanted to thank you for you honest post. The latter stages of this horrible disease are very often the elephant in the room. The forum used to have a number of women who had experience and knowledge if your position, sadly they no longer post. 

Have you spoken to the nurses on this site, unfortunately they don't work weekends.

Thanks Chris 

User
Posted 09 May 2026 at 08:05

I’m sorry to read this. Have you considered contacting your local hospice for further advice on pain management and quality of life. Your GP states palliative not available until she can’t control the pain but I if I’ve understood correctly the pain is uncontrolled. I hope you can get some support very soon.  

User
Posted 09 May 2026 at 13:05

Hello.

I'm so sorry to hear that your husband is suffering. Years ago my dad was in a similar position. In the end,  I had him assessed by social services, district nurses and MacMillan nurses. They all did their best to make him as comfortable as possible. I was most impressed by Macmillan nurses they were wonderful.

My heart goes out to you both. I hope you get the help that you deserve.

Edited by member 09 May 2026 at 22:07  | Reason: Additional text

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User
Posted 08 May 2026 at 22:10

Schubert, sorry I don't have any answers or advice to offer, but wanted to thank you for you honest post. The latter stages of this horrible disease are very often the elephant in the room. The forum used to have a number of women who had experience and knowledge if your position, sadly they no longer post. 

Have you spoken to the nurses on this site, unfortunately they don't work weekends.

Thanks Chris 

User
Posted 09 May 2026 at 08:05

I’m sorry to read this. Have you considered contacting your local hospice for further advice on pain management and quality of life. Your GP states palliative not available until she can’t control the pain but I if I’ve understood correctly the pain is uncontrolled. I hope you can get some support very soon.  

User
Posted 09 May 2026 at 12:12
Thank you ColwickChris and Wedidntwantthis. All very helpful suggestions which I will follow up. I have also been looking into how some people don’t respond well for pain reduction to Morphine, especially for neuropathic pain which may be what OH has from his insufficiency fracture. I will research more so we are well prepared for our next conversations with the GP and others and keep this post up to date as we progress because I am sure it will help others. We are only 3.5 years into PC and I am surprised to be at this dreadful stage so soon.

Thanks

User
Posted 09 May 2026 at 13:05

Hello.

I'm so sorry to hear that your husband is suffering. Years ago my dad was in a similar position. In the end,  I had him assessed by social services, district nurses and MacMillan nurses. They all did their best to make him as comfortable as possible. I was most impressed by Macmillan nurses they were wonderful.

My heart goes out to you both. I hope you get the help that you deserve.

Edited by member 09 May 2026 at 22:07  | Reason: Additional text

User
Posted 10 May 2026 at 06:53
Insist on a referral to the pain management team, district nurses and Macmillan.

The GP doesn't make any sense, every medical professional should know letting pain get out of control is a mistake. So waiting is not an option in your case IMHO.

 
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