Metastatic bone pain: treatment options with an emphasis on bisphosphonates.
BACKGROUND
One of the key targets for metastatic cancer cells is the skeleton. Once metastatic cells are established within the bone matrix, skeletal integrity becomes increasingly compromised. Bone lesions lead to various complications, including bone pain, fractures and spinal cord compression.
Bone pain is debilitating and affects quality of life of the patient. In addition, it increases the use of health care resources. Many patients with metastatic bone disease experience substantial bone pain despite state-of-the-art systemic analgesic treatment. Incident pain is the predominant pain syndrome.
Typically, this syndrome requires moderate baseline analgesia with increased on-demand doses. Other techniques for treating bone pain, including radiation therapy, neuraxial application of analgesics, nerve blocks and local stabilisation procedures, should be considered. In addition, therapy with bisphosphonates targeting bone-specific pain is an important strategy. This review discusses the various management options for bone pain arising from metastatic bone disease.
von Moos
Roger
R
Medical Oncology, Kantonsspital Graubünden, Loestrasse 170, Chur, 7000, Switzerland. roger.vonmoos@ksgr.ch
Strasser
Florian
F
Gillessen
Silke
S
Zaugg
Kathrin
K
D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000503:physiopathology* / Q000556:secondary*; D004164:Diphosphonates / Q000627:therapeutic use*; D006801:Humans; D010148:Intractable Pain / Q000188:drug therapy*; D010166:Palliative Care; D011788:Quality of Life
D050071:Bone Density Conservation Agents; D004164:Diphosphonates