Bicarbonate for Tumor Related Pain

Inclusion Criteria:

* Patients must have metastatic or unresectable solid malignancy or hematologic malignancy (multiple myeloma or lymphoma) and must have moderate to severe tumor related pain (VAS\>4) on a stable opioid regimen (at least 3 days of an opiate regimen).
* No planned palliative surgery, palliative radiotherapy for at least 2 weeks. However prior radiotherapy, and surgery is allowed and not limited to the number of procedures and courses. Concomitant chemotherapy is allowed. In addition, when it is anticipated that chemotherapy may result in rapid pain relief (less than 2 weeks), patients will only be enrolled after completing their first cycle of chemotherapy and provided their pain level is greater than 4 on the VAS.
* No evidence of neurologic or psychiatric compromise which in the opinion of the investigator will interfere with completion of study assessments
* Life expectancy greater than 3 months
* Age greater than 18 years and able to understand and sign the informed consent document
* Patients must have an Eastern cooperative oncology group (ECOG) performance status less than 4.

Exclusion Criteria:

* Patients with neuropathy and/or neuropathic pain as the only pain syndrome are not eligible. Patients with chronic non malignant pain are not eligible.
* Patients with renal insufficiency (creatinine \> 2.5 mg/dL) are excluded
* Patients with history of congestive heart failure or pulmonary artery hypertension will be excluded
* Any patient who in the opinion of the investigator is dehydrated at the time of initial evaluation will be excluded.
* Patients with uncontrolled hypertension (systolic pressure \>140, diastolic pressure \>90) despite maximal antihypertensive therapy.
* Patients unable to ingest of oral sodium bicarbonate (such as patients with dysphagia or severe nausea)
* Patients with ECOG performance status 4
* Patients with acute leukemia, myelodysplastic syndrome, and chronic myeloid leukemia are not eligible.
* Pregnant or lactating patients are not eligible.
* Patients with estimated survival less than 3 months
* Patients with known allergy to sodium bicarbonate or patients with preexisting renal or acid base disorders for which sodium bicarbonate is contraindicated (such as metabolic alkalosis, severe congestive heart failure, hypernatremia, and hypocalcemia \[see above\]).
* Patients with severe ongoing infections which places the patients at increased risks from therapy in the opinion of the investigator.
* Patients who are receiving and or will receive, during their participation in study, an oral chemotherapeutic agent whose bioavailability could be altered by the ingestion of sodium bicarbonate.