Management of painful bone metastases

PURPOSE OF REVIEW: This review examines recent data on the pathophysiologyand mechanisms of bone pain; it highlights the use of multiple andinterdisciplinary treatments rather than sole use of traditional analgesics.RECENT FINDINGS: Bone pain has been shown to have a unique pathophysiology.Recent experimental (animal) models have revealed that, parallel toincreased bone destruction, ipsilateral spinal cord segments that receiveprimary input from the cancerous femur exhibit several notable neurochemicalchanges. These mandate the use of opioid doses sufficient to inhibit theobserved nociceptive behaviours; these doses are greater than those requiredto alleviate pain behaviours of comparable magnitude generated byinflammatory pain. Several substances have been tested in this animal model.SUMMARY: According to new preclinical data, treatment of bone cancer painrequires multidisciplinary therapies such as radiotherapy applied to thepainful area along with systemic treatment (hormone therapy or chemotherapy)and supportive care (analgesic therapy and bisphosphonates). In someselected cases use of radioisotopes and other noninvasive or minimallyinvasive techniques may be useful in the management of metastatic bone pain.The treatment should be individualized according to the patient''s clinicalcondition, life expectancy, and quality of life. Language of originaldocument