Up to 90% of patients with metastatic or advanced stage cancer will experience
significant cancer-related pain. Approximately half or more of patients diagnosed with
cancer may experience bone pain. It has been estimated that tumor metastases to
the skeleton affect roughly 400,000 United States citizens annually. Carcinoma from
breast, lung, and prostate cancers account for about 80% of secondary metastatic
bone disease. Bone metastases may cause devastating clinical complications associated
with dramatic reductions in quality of life, mobility, and independence as well as
excruciating refractory pain. Associated complications from osseous metastases also
present a substantial economic burden. Currently, there is still a significantly high
number of patients suffering with unrelieved pain from osseous metastases.
Treatments for painful osseous metastases may not only diminish pain, but may also
improve quality of life and independence/mobility, and reduce skeletal morbidity,
potential pathologic fractures, spinal cord compression, and other “skeletalrelated events.” Treatment strategies for painful osseous metastases include
systemic analgesics, intrathecal analgesics, glucocorticoids, radiation (external beam
radiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation
(RFA) and cryoablation), bisphosphonates, chemotherapeutic agents, inhibitors of
RANK-RANKL interaction (e.g., denosumab), hormonal therapies, interventional
techniques (e.g., kyphoplasty), and surgical approaches. Although the mechanisms
underlying the development of bone metastases are not completely understood,
there appears to be important bi-directional interactions between the tumor and the
bone microenvironment. A greater understanding of the pathophysiology of painful
osseous metastases may lead to better and more selective targeted analgesic therapy.
Additionally, potential future therapeutic approaches to painful osseous metastases
may revolutionize approaches to analgesia for this condition, leading to optimal
outcomes with maximal pain relief and minimal adverse effects.
Key words: Cancer pain, metastasis, osseous metastasis, bone pain, radiation
therapy, radiopharmaceuticals
Painful Osseous Metastases
