Features of pain syndrome in patients with bone metastasis

Purpose. The purpose of the current study was the search for evaluation criterion for the radiosensitivity of bone metastases of various origins. Materials and methods. The first part of the study presents a modern classification of pain, method of its evaluation, mechanisms and features of metastatic bone pain. The radiobiological patterns of pain relief in low-dose anti-inflammatory radiation therapy were also considered. The analysis of these features testifies in favor of the antitumor mechanism of pain relief in high-dose irradiation. To identify the relationship between pain and other clinical symptoms, 810 cases of bone metastases of various localization and morphology were analyzed. Results. The severity of pain directly correlates with gender, lesion length and little affected by the presence of pathological fracture. The intensity of pain does not depend on the primary tumor and bone metastases localization and does not correlate with the presence of neurological deficit. Conclusion. Completeness and persistence of the analgesic effect may reflect the real radiosensitivity of bone metastases, but taking into account the patient's gender and lesion length in the irradiated area.

Corydalis Saxicola Bunting Total Alkaloids Attenuate Walker 256-Induced Bone Pain and Osteoclastogenesis by Suppressing RANKL-Induced NF-κB and c-Fos/NFATc1 Pathways in Rats

Metastatic bone pain is characterized by insufferable bone pain and abnormal bone structure. A major goal of bone cancer treatment is to ameliorate osteolytic lesion induced by tumor cells. Corydalis saxicola Bunting total alkaloids (CSBTA), the alkaloid compounds extracted from the root of C. saxicola Bunting, have been shown to possess anticancer and analgesic properties. In this study, we aimed to verify whether CSBTA could relieve cancer induced bone pain and inhibit osteoclastogenesis. The in vivo results showed that CSBTA ameliorated Walker 256 induced bone pain and osteoporosis in rats. Histopathological changes also supported that CSBTA inhibited Walker 256 cell-mediated osteolysis. Further in vitro analysis confirmed that CSBTA reduced the expression of RANKL and downregulate the level of RANKL/OPG ratio in breast cancer cells. Moreover, CSBTA could inhibit osteoclastogenesis by suppressing RANKL-induced NF-κB and c-Fos/NFATc1 pathways. Collectively, this study demonstrated that CSBTA could attenuate cancer induced bone pain via a novel mechanism. Therefore, CSBTA might be a promising candidate drug for metastatic bone pain patients.

Caudal Epidural for Pain Management of Prostate Cancer

Prostate cancer is the second commonest cancer found in men. Pain can occur in both early and advanced stages of prostate cancer, with an incidence of 30-50%. The pain can be caused directly by the cancer or related to the cancer treatment. Currently, pain in prostate cancer is managed with surgery, medication, radiotherapy or chemotherapy. It can also be managed by intra-thecal morphine, psoas sheet catheter and superior hypogastric block. However, all these procedures involve risks. We present a case of Stage 4 Prostate Cancer who presented with severe lower back pain. We performed a caudal epidural, which was very successful to reduce the patient's pain and improve his quality of life. We recommend a caudal epidural should be considered as an option to manage metastatic bone pain in prostate cancer patients.

Denosumab-induced hypocalcaemia in metastatic gastric cancer

Hypocalcaemia in malignancy is infrequently reported and the underlying cause is often multifactorial. Denosumab, an antiresorptive medication, can be used to treat a number of cancer-related complications including hypercalcaemia, metastatic bone pain and to reduce fracture-events. We present a case of a hospice inpatient with profound and recurring hypocalcaemia following a single denosumab infusion which required repeated hospitalisation, for intravenous calcium, alongside a prolonged course of vitamin D and electrolyte replacement. The case highlights the risk of hypocalcaemia with denosumab use, together with the need to identify and treat vitamin D deficiency in both the prevention and management of such a complication.

Targeted Palliative Radionuclide Therapy for Metastatic Bone Pain

Bone metastasis develops in multiple malignancies with a wide range of incidence. The presence of multiple bone metastases, leading to a multitude of complications and poorer prognosis. The corresponding refractory bone pain is still a challenging issue managed through multidisciplinary approaches to enhance the quality of life. Radiopharmaceuticals are mainly used in the latest courses of the disease. Bone-pain palliation with easy-to-administer radionuclides offers advantages, including simultaneous treatment of multiple metastatic foci, the repeatability and also the combination with other therapies. Several β¯- and α-emitters as well as pharmaceuticals, from the very first [89Sr]strontium-dichloride to recently introduced [223Ra]radium-dichloride, are investigated to identify an optimum agent. In addition, the combination of bone-seeking radiopharmaceuticals with chemotherapy or radiotherapy has been employed to enhance the outcome. Radiopharmaceuticals demonstrate an acceptable response rate in pain relief. Nevertheless, survival benefits have been documented in only a limited number of studies. In this review, we provide an overview of bone-seeking radiopharmaceuticals used for bone-pain palliation, their effectiveness and toxicity, as well as the results of the combination with other therapies. Bone-pain palliation with radiopharmaceuticals has been employed for eight decades. However, there are still new aspects yet to be established.