IMPLICATIONS FOR NURSING PRACTICE
The therapeutic relationship with your patient can facilitate early identification of changes in a patient’s functional status that may be secondary to significant new or progressive back pain. Nurses can initiate discussions with members of the health care team regarding the change in patient status and the possible role of percutaneous vertebroplasty in a patient’s care plan. When a consensus that the patient is an appropriate candidate for vertebroplasty is reached, patient education about the goals of treatment, the potential risks and benefits, and the procedure itself is a critical first step.
The results of the pain assessment and the imaging studies are included in the consultation process with the oncology, radiology, and neurosurgery departments. A formal referral, which includes all vertebral imaging results, is sent to an interventional radiologist, who can assist in identifying vertebrae that may be amendable to treatment.8
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Nurse assessment of potential candidates’ initial (baseline) pain should be performed using a validated pain inventory; this same inventory should then be used in the postprocedure and follow-up assessments to ensure consistency. A visual analogue scale (VAS) of pain is one of the most common inventories used among patients with myeloma. However, it is not inclusive of the other symptoms and disabilities experienced by patients with myelomatous VCFs. The Roland-Morris Disability Questionnaire is a more reliable outcome measure for evaluating the preoperative status and the postoperative efficacy of vertebroplasty.9,11,12 This tool is easily accessible (available online), simple to administer, well-validated, specific to back pain, and appropriate for assessing vertebroplasty outcomes.12
Because the pain relief from vertebroplasty can be sustained for 6 months or longer, the outcome assessment should be used at baseline, and repeated at 1 week, 1 month, 6 months, and 1 year postoperatively.9 This pre- and postoperative comparison documents the outcome of vertebroplasty for pain relief and improved quality of life.
Appropriate aftercare of the patient includes nursing-directed health teaching, particularly with respect to the increase in mobility that is expected with optimized pain control. Patients should be encouraged to resume activity as tolerated, but to avoid heavy lifting for at least 6 weeks. A timely referral to physiotherapy is indicated for guidance regarding gentle exercise in the postoperative period.4
CONCLUSION
Since its inception in the 1980s, percutaneous vertebroplasty has proven to be a safe, effective, and durable treatment for the pain associated with vertebral compression fractures.3 Among patients with vertebral fractures secondary to multiple myeloma, vertebroplasty is an important adjunct to other standard treatments such as analgesic medications, systemic treatments, and radiation therapy.5 The procedure is known to provide rapid pain relief, decrease disability, and significantly improve patients’ quality of life. Therefore, all affected patients should be assessed as potential candidates for vertebroplasty.
Members of the nursing profession are an integral part of the patient care team as both advocates and assessors of patient status particularly in patients with multiple myeloma and painful malignant vertebral compression fractures. Their contribution can ensure patients receive the most effective treatments.
Acknowledgment The authors dedicate this article to the respectful memory of Dr. Ade Olujohungbe and his compassionate care for patients with multiple myeloma. They also thank Ruth Holmberg, librarian at CancerCare Manitoba, for her assistance with the literature search for this article.
Jayne Kasian is a nurse practitioner at CancerCare Manitoba, in Winnipeg, Manitoba, Canada. Laura Johnson is a nurse practitioner in the emergency department at Health Sciences Centre, and an instructor at the University of Manitoba in Winnipeg, Manitoba, Canada, in the Nurse Practitioner program.
REFERENCES
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12. Trout AT, Kallmes DF, Gray LA, et al. Evaluation of vertebroplasty with a validated outcome measure: the Roland-Morris Disability Questionnaire. AJNR Am J Neuroradiol. 2005;26(10):2652-2657. http://www.ajnr.org/cgi/pmidlookup?view=long&pmid=16286418. Accessed November 6, 2013.
