Management of painful bone metastases.
OBJECTIVE
This review examines recent data on the pathophysiology and mechanisms of bone pain; it highlights the use of multiple and interdisciplinary treatments rather than sole use of traditional analgesics.


RESULTS
Bone pain has been shown to have a unique pathophysiology. Recent experimental (animal) models have revealed that, parallel to increased bone destruction, ipsilateral spinal cord segments that receive primary input from the cancerous femur exhibit several notable neurochemical changes. These mandate the use of opioid doses sufficient to inhibit the observed nociceptive behaviours; these doses are greater than those required to alleviate pain behaviours of comparable magnitude generated by inflammatory pain. Several substances have been tested in this animal model.


CONCLUSIONS
According to new preclinical data, treatment of bone cancer pain requires multidisciplinary therapies such as radiotherapy applied to the painful area along with systemic treatment (hormone therapy or chemotherapy) and supportive care (analgesic therapy and bisphosphonates). In some selected cases use of radioisotopes and other noninvasive or minimally invasive techniques may be useful in the management of metastatic bone pain. The treatment should be individualized according to the patient's clinical condition, life expectancy, and quality of life.
Mercadante
Sebastiano
S
Anesthesia & Intensive Care Unit - La Maddalena Cancer Center, University of Palermo, Palermo, Italy. terapiadeldolore@la-maddalena.it
Fulfaro
Fabio
F
D000700:Analgesics / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000503:physiopathology*; D002116:Calcitonin; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D011868:Radioisotopes; D011878:Radiotherapy
D000700:Analgesics; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D011868:Radioisotopes; D002116:Calcitonin