Celebrex - Can it mask bone met pain?

Ladies,

I'm Stage 3b...and my Dr has me on 200 mg Celebrex, for bone pain. He said it wouldnt mask the pain if it was bone mets. But i think i read on here somewhere that Drs are using Celebrex to effectivly treat bone met pain. I've had bc twice....15 yrs apart. My scans vary back n forth for up to 8 painful ribs areas, both sides, being "suspicious for mets" to being cleared as "healing fractures"...most I dont know how fractured...but never dx w bone met. In Jan, 4 ribs re-fractured just by leaning. I dont have osteoporsis. I just tried to wean off Celebrex, and this time, pain much worse in old fractured rib area from 2009.

What have your drs told you about Celebrex and bone met pain? I'm on 200mg...could that mask a early bone met?

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Hi Marcinca,
Before I was diagnosed with bone mets my family doctor treated the bone pain in my sternum with celebrex. He thought I had costochondritis, an inflammation of the cartilage where the ribs join with the sternum. It did nothing to ease this pain, which turned out to be bone mets. So, in my case, your doctor is right, celebrex won't mask the pain of bone mets.

I hope you find the solution to your pain, and that it's not bone mets.

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For 11 months all I needed was an occasional ibuprofen for my extensive bone mets. Ibuprofen and Celebrex are of the same Nsaid family. ANYTHING that works to kill pain...be it acupuncture, opiates, mental control, could be said to "mask" another situation.
Personally I think a bone biopsy would be in order for you..."suspicious"areas leave you in a medical limbo without other treatments that might be prescribed as well as analgesics.

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I had bone biopsy in 1 rib area in 2009....that was clear. Now drs say too many spots show on ribs now and even taking sev biopsy not conclusive enough .

My onc said if he knew bone mets confirmed he'd not change my current regimen of tamoxifen only.

Does that seem reasonable??

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The most usual thing would be to prescribe phosphonates if there's bone mets. Are your calcium levels watched in routine blood tests?

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Even with extensive bone mets a negative result can happen (it means they don't visualize excessive and abnormal cell division nor breast cells in bone.) But one positive result would confirm. Sometimes the affected area isn't an easy one to biopsy and I've run into professionals that simply aren't comfortable with the procedure. Mayo Clinic recommended it for me to 1. confirm bone mets and 2. see if on the off chance the receptors were different from the primary tumour-sometimes happens.

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I have osteoarthritis and was prescribed celebrex. I especially needed it from the intense pain in the joints I got from the life time dose of taxotere given in 2004 when I was stage III. I've been on celebrex ever since, I weaned myself down to 100 mg.s per day and occasionally take a holiday from it, per 'that would be a good idea' from the Doc.
The bone pain and the arthritis pain are distinctly different in my case. I can tell which is which.
Don't know what your case would be and with 200mgs. it might be different yet.

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I think you need a second opinion asap. Have you had a PET scan? If you're bone issues appear to be increasing or progessing, then I wouldn't think it's a good idea to stay with current treatment of tamoxifen. They need to figure you what's going on.

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I have to agree with Blindsided here.
Get a 2nd opinion and perhaps a PET scan.
Biopsies can come back false negative. With as many bone "issues" as you describe, I think it's VERY important to find out definitively what is going on. I don't want to scare you, but it was repeated fracturing ribs that led to my own breast cancer diagnosis in 2003.
If these turn out to be mets, then it would signal the need to change treatments.
That said, there are MANY options for you regarding treatment... several hormonal therepies besides Tamoxifen. Also, you may be a candidate for bisphosphonates like Zometa etc to help strengthen bone.
To answer your question, yes Celebrex can and often will mask bone met pain. I was on it for almost 3 years for pain related to my bone mets and it really helped alot. I wish I could still take it, but my oncologist pulled me off of it due to concerns about cardio-vascular risks.
I do hope you go see someone and have a thorough evaluation to get to the bottom of this issue - sooner than later.
Best of luck to you.

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A second opinion........ASAP. Of course the Celebrex can give relief, that's what it is for. The main question is.........do you have mets? Stage 3, doesn't show up in bones......stage 4........Why on earth would you have fractures in your ribs? No rheumatoid arthritis? No osteporosis? It is not normal to have spontaneous fractures, unless there were a weakening of some kind. It is natural to question the presence of mets in your effected ribs.

A second opinion........ASAP. If you are on tamoxifen and have mets........your meds need to be altered. Even if they need a sample to confirm.......it's a heck of a lot better than waiting. A PET or CT or MRI, maybe all three may be necessary to confirm.

Rib fractures?? Seriously??..........Why is your oncologist not trying to figure this out???

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Marcinca,
I went back and read your story. You've had so many rib fractures........What do they attribute it to?? Are you on a biphosphate??
What happened with the nodes in your lungs? Why are you only on tamoxifen?? What are your oncologists waiting for??

A lot of questions. Sorry........you may want to write them down and ask the oncologists.

You had a skin met and it sounds like the oncologist doubted it then.
For the 3rd time.........get another opinion ASAP.

My story.............one had PET, CT, and MRI done at the onset.........When I had so much pain, I was seeing a chiropractor, is made an appointment with my oncologist. I'd had the same 3 scans again.
The initial scans were completely clean, except a small spot on my pelvis and one vertebrae......they called it 'artifact', because it wasn't on the CT or PET.......it was only on the MRI. When I couldn't take the pain anymore......I had scans repeated.
They were clean on PET/CT......but MRI shoes the 'artifact' was much larger.
I had a bone marrow biopsy done on the pelvic spot..........it was BC.......I was stage 4 from the beginning..........but treated as stage 3 b.

It is possible to have some diagnostic test to give false negatives.
This is where you gut instinct must override the oncologist...............Just gather all your tests films and bring them to another oncologist........preferably..........someone with better skills. Doctors have 'a practice', sometimes they become arrogant and don't want to be questioned. If you cannot be a part of your own 'team', then it's time to pick a different coach. You are your best advocate. Only you.......are aware of what your body is feeling..........to not have a physician listen to 'you'......Is enough to fire his a*s.
Broken ribs! If it's from osteoporosis .........you ought to be on biphosphates.
If your markers are normal......that isn't unusual. Markers aren't reliable. Of course, there are a few different markers to test. How about checking a different set.
There is a sense of urgency...........with your situation. If you have distal mets, your treatment needs to be changed.

Take care...........Prayers, Anita

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I am on Cymbalta, not Celebrex, and it works amazingly well for bone mets pain. Just throwing that in there in case it's helpful.

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I agree with everyone about getting a 2nd opinion but I would also bluntly like to add that your Oncologist is a quack!!! Dump him!!!!
I take Celebrex, which is a Cox 2 Inhibitor and it works great for the intended prescribed needs, if it helps your inflammation then use it, not going to hurt you one way or the other considering everything else that is going on.

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fragilistic....whats pain difference do you notice btwn bone met pain and arthritis pain?

CSF...you kept fracturing your ribs that led to dx? were you easily fracturing them? did they take a long time to heal? or never heal completely? what tests did they do to find it? do you still fracture them easily? thank you so much for saying there are many options if mets.

ok, i just went off celebrex....waiting to see what rib pain does!
(side note....just realized altho celebrex v effective for a long while, think i was hving some side effects like rapid unexplnd wt gain and painful swollen ankles and feet. two days off celebrx now,and those things better already)

Testing - i had a lot of PETs, bone and ct scans 2009-2011....with false negatives and false positives. (no mri's in sev yrs) lung spots were clear in last scan.
no scans in 2012, yet or planned, which worries me.
if rib pain continues.....should i ask for the works....the MRI, CT and PET? bonescans seem to show a lot of ribs spots/fractures that are "inconclusive" and not well defined.

i've had 5 second opinions on this since 2009 !! most top drs at ucla. since 2009, with new breaks and suspicious results, and bec i was first dx in 1995 w/out cleared tumor margins, drs seem to go thru a flurry of being worried about ribs, then not. they now tend toward, "its just her ribs being weird, again" ...which reminds me of the boy who cried wolf. and some drs now fight to not "over test" me and none can agree on which is "best" test to get conclusive results. and its been SO difficult to get my 3 cancers dx, i'm really skeptical now....espec w ongoing pain and concerns.

the bone specialist has put me thru extensive testing and concluded its def not osteoporosis. there is mild osteopenia...she cannot explain the ongoing easily broken ribs. i've been under drs care to strengthen bones w supplements/diet/exercise for 1.5 yrs. if no improvement soon, i'll have to rethink bone building meds...i havent gone on yet bec sev drs told me to wait as long as i could. one theory on why my bones break easily and dont heal well is bec of all the bc treatment/surgeries/meds over a # of yrs ....but its not conclusive enough for me.

my bc blood wk IS elevated now...higher than when i was dx w bc both times, which worries me. onc said thats cuz new lab/new test. hmmmm. ;/ calcium levels good. both tests will be rechecked in a few wks.

and you gals probably get this..... it upsets my husband when i start saying there is more pain and i prob should talk to dr about having another scan, and insist on one even if dr doesn't think so.....

mar

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To me, the arthritis is aching pain and the bone pain is more sharp. That's with me. You situation is a puzzlement.

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Hey Mar-
To try to answer, I fractured 3 ribs over about 4 months usually unanware at the time it happened but was in pain for about 2-3 weeks after each one. I didn't know they were fractured until the doctor at the clinic I was going to decided to do an X-ray on the 3rd one, finding the fracture. Hairline fractures - no complete breaks - that seemed to happen on their own with no trauma.

It was about 4 or 5 months later that I found my 2nd breast lump and decided that mammograms weren't sufficient (came back negative always) so asked for ultrasound. That led to biopsy confirming BC, and when I told the oncologist at our first meeting about the ribs he ordered CT and bone scans which showed the whole picture (very widespread mets to most bones and both lungs).
Treatment began with Femara (hormonal) and Zometa (bisphosphonate to help rebuild bone) and I had only 1 further fracture of a rib after that. I have fractures in a couple of my vertebrae, but they happened over the 8+ yrs now since diagnosis. The Zometa, I believe, helped ALOT and though I cannot take anymore due to some side-effects I am so happy I had it then.

Hope this info helps. Be persistent and you will get answers eventually. BTW, I am aware that radiation for early BC can cause brittle bones sometimes... maybe your rib issues are in fact late effects from your earlier BC treatments? Also, your change in "blood work" results can be from switching labs. I have had that happen. The only way to know is to re-test in a while (maybe a month or so?)
Either way, you need answers not guesses and dismissal. Keep pushing until you are satisfied with the answers you are getting. Good luck!

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ribs acting in a "weird" way is the most unpropfessional thing I've heard yet. An excellent doctor will be thrilled by the diagnostic challenge that you present, he'll study all your data, give you a diagnostic differential-a list of possibilities to check through and eliminate or say "yes" this is probably it. He will not brush you off nor wait and see. Enough is enough.

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csf - thanks so much for info and more of your story....am so glad you are eight plus yrs out. i re read "eight plus" sev times. cant imagine getting that ct/bone scan news.

did your fracture/hairline breaks ache for sev yrs? my areas still hurt 3 yrs later, if i'm not on pain med.
do you think the zometa med helped w the breaks and the pain assoc?

you are so right about early bc rad might cause brittle bones/ribs yrs later... i had 6wks bc rad, twice, 1995 and 2010..on same right side...drs said those rads a factor on that one side...both causing more breaks and impeding healing.

but its my left, non rad side ribs, that broke first ( in 2009, with no known reason), and hurting most now. the pain on this side, in sev rib areas, has never really gone away for long. 4 mo's ago, i leaned for a few hrs talking w someone, and all those 2009 breaks reactivated...so painful. it still hurts, and wakes me up at night, if i'm not on pain med. does that sound like your experience w ribs/pain/healing problems ?


potra - you rock.

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