Changes in DTRs are a red flag for metastatic cancer pain.

Changes in DTRs are a red flag for metastatic cancer pain.

• A. False
• B. Only with cancer history
• C. Only in elderly
• D. True

Answer: (D)

Changes in deep tendon reflexes signal possible nervous system involvement from cancer spreading to the spine or brain, which is a red flag in cancer-related pain. When metastases press on the spinal cord or nerve roots, reflex patterns can change—hyperreflexia and possibly clonus if an upper motor neuron pathway is affected, or hyporeflexia/areflexia if there is acute lower motor neuron involvement like cauda equina or nerve root compression. Either pattern indicates potential serious neurologic compromise, so this finding should prompt urgent imaging and referral. This concern applies regardless of age or whether there is a long-standing cancer history; new or changing DTRs in a patient with cancer pain point toward possible metastatic disease and require thorough evaluation, alongside other red flags such as new weakness, numbness, gait disturbances, and bowel or bladder changes.

Changes in deep tendon reflexes signal possible nervous system involvement from cancer spreading to the spine or brain, which is a red flag in cancer-related pain. When metastases press on the spinal cord or nerve roots, reflex patterns can change—hyperreflexia and possibly clonus if an upper motor neuron pathway is affected, or hyporeflexia/areflexia if there is acute lower motor neuron involvement like cauda equina or nerve root compression. Either pattern indicates potential serious neurologic compromise, so this finding should prompt urgent imaging and referral.

This concern applies regardless of age or whether there is a long-standing cancer history; new or changing DTRs in a patient with cancer pain point toward possible metastatic disease and require thorough evaluation, alongside other red flags such as new weakness, numbness, gait disturbances, and bowel or bladder changes.