Management of Bone Pain Secondary to Metastases

Bone pain secondary to metastases decreases the quality of life of the patients who have a relatively longer survival. For the purpose of pain relief in bone metastases available modalities include analgesic drugs, radiation therapy, corticosteroids, nerve blocks, radiopharmaceutical agents, biphosphonates and surgical procedures. Analgesic drugs should be prescribed in all patients as per the WHO guidelines. Palliative single fraction radiotherapy to the appropriate target volume is recommended for metastatic bone pain relief. Radionuclide therapy is used for multifocal painful bone metastasis both above and below the diaphragm where increased uptake in painful lesions is demonstrated on bone scan. Bisphosphonates ease the symptoms of bone metastases by decreasing the activity of osteoclasts. Surgical intervention is required for patients with non vertebral metastatic lesions > 2.5 cm in diameter or with lesions located in weight bearing areas. Thus treatment needs to be individualized for adequate pain relief.