Painful Boney Metastases

Abstract

Boney metastasis may lead to terrible suffering from debilitating pain. The most likely malignancies that spread to bone are prostate, breast, and lung. Painful osseous metastases are typically associated with multiple episodes of breakthrough pain which may occur with activities of daily living, weight bearing, lifting, coughing, and sneezing. Almost half of these breakthrough pain episodes are rapid in onset and short in duration and 44% of episodes are unpredictable. Treatment strategies include: analgesic approaches with "triple opioid therapy", bisphosphonates, chemotherapeutic agents, hormonal therapy, interventional and surgical approaches, steroids, radiation (external beam radiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation, cryoablation), and intrathecal analgesics. (Korean J Pain 2013; 26: 223-241)

End‐of‐life care in the head and neck cancer patient

“…In cases of bone pain, NSAIDS can be used in an adjuvant role with opioids. Nociceptive pain management may be well managed by use of opioids (oral, transdermal, parenteral), short-course multifraction radiotherapy, and other modalities in cases of metastatic bone pain (Johnstone and Lutz, 2014;Smith and Barkin, 2014). An additional modality for cancerrelated bone pain that has been shown to be effective in various forms of malignancy is the use of drugs in agents inhibiting the RANKL-RANK interactive pathway such as bisphosphonates and denosumab (Gul et al, 2016).…”

Efficacy of Cryoablation to Control Cancer Pain: A Systematic Review

“…Lesions located < 1 cm from high-risk zones such as a large blood vessels or nerves, the spinal cord, the Adamkiewicz artery, or the bladder are excluded in most studies. 2 Antibiotic prophylaxis and the type of anesthesia (local, general, sedation) vary widely. Computed tomography (CT) is the most common intraoperative imaging technique for lesion localization, but magnetic resonance imaging (MRI) and ultrasound are also described in the literature.…”

Chemokine receptor CXCR4 regulates CaMKII/CREB pathway in spinal neurons that underlies cancer-induced bone pain

“…Recent epidemiological studies have demonstrated that approximately half or more of patients with metastatic or advanced osteocarcinoma experience daily moderate to severe cancer pain, which severely disrupts their quality of life 2 . Cancer pain symptoms, generally consisting of pathological breakthrough (or incident) pain and ongoing pain, are inadequately managed by using conventional analgesics and therapies, which are partially because of our current poor understanding of the specific mechanisms of this pain 3 .…”