Managing metastatic bone pain

Patients associate advanced cancer with pain, and for many such patients the source of the pain will be metastatic bone disease. Bone is one of the most frequent sites of spread for many common cancers such as breast, prostate, lung, and kidney and is usually affected in multiple myeloma.1 Active management of metastatic bone disease can, however, control the symptoms and in many cases prevent further complications such as pathological fracture or compression of the spinal cord.2

What can be done? Firstly, patients should be given analgesics and considered for appropriate systemic treatment for the underlying cancer, usually hormonal treatment or chemotherapy. Secondly, patients should be considered for specific treatment for the bone metastases, the principal modalities being radiotherapy and bisphosphonates.

Radiotherapy has long been used. It is most commonly given as external beam to the most painful site or sites. Does it work, and how should it be given? Assessing reduction in pain in patients …