Clinical case · Palliative care
Bone pain, drowsy and constipated
An 84-year-old man with prostate cancer spread to his bones has severe back pain, and his painkillers are making him drowsy and constipated. Rebuild his pain relief safely around his kidney function and frailty.
Intermediate 15 minNeeds clinical review
You will learn to
- Recognise harm from common analgesics in a frail older person with kidney impairment
- Match analgesia to pain severity and choose and titrate opioids safely
- Manage the companions of pain: constipation, sleep, mood and carer support
Presentation
Step 1 of 10You visit an 84-year-old man at home. He has prostate cancer with bone metastases in his spine and pelvis, diagnosed a year ago and treated with hormone therapy by his oncologist.
Over three weeks his lower back pain has become severe. His wife says, "He's sleeping all day, he's confused in the evenings, and he hasn't opened his bowels for five days."
References
- Li D, Yang Y, Zhang Y, et al. Guideline for Medication Management of Distressing Symptoms in Older Patients Receiving End-of-Life Palliative Care. J Evid Based Med. 2026;19(3):e70160. doi:10.1111/jebm.70160 · PubMed 42433014
- Van den Block L, de Nooijer K, Pautex S, et al. A European Association for Palliative Care White Paper defining an integrative palliative, geriatric, and rehabilitative approach to care and support for older people living with frailty and their family carers: a 28-country Delphi study and recommendations. EClinicalMedicine. 2025;87:103403. doi:10.1016/j.eclinm.2025.103403 · PubMed 40838200
Last updated 2026-10-21.
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