Clinical Review

Cancer induced bone pain

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h315 (Published 29 January 2015) Cite this as: BMJ 2015;350:h315
  1. Christopher M Kane, NIHR academic clinical fellow in palliative medicine1,
  2. Peter Hoskin, professor of clinical oncology2,
  3. Michael I Bennett, St Gemma’s professor of palliative medicine1
  1. 1Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
  2. 2Mount Vernon Cancer Centre, Northwood, University College London, London, UK
  1. Correspondence to: C M Kane Christopher.Kane{at}nhs.net

The bottom line

  • Cancer induced bone pain is a common problem, which can be extremely debilitating to patients with an already limited life expectancy

  • When treating cancer induced bone pain, maintenance of function should be given high priority alongside pain relief

  • Early recognition, intervention with functional aids, and behaviour modification, combined with initial titration with analgesia (commonly, strong opioids) are important first steps for non-specialists

  • The evidence for early referral for radiotherapy is strong, although bisphosphonates will have an important role for some patients

  • Specialist support will be required if pain persists despite initial treatment with behaviour modification, commencement of a non-steroidal anti-inflammatory drug, and initial titration of a strong opioid

Bone pain is the most common type of pain from cancer and is present in around one third of patients with bone metastases.1 2 Based on postmortem studies of patients with advanced cancer and clinical knowledge of how often bone metastases result in pain, the incidence of cancer induced bone pain is estimated at 30 000 patients in the United Kingdom each year.3 w1 Currently, improvements in cancer treatments mean that many patients are living with metastatic cancer for several years. The prevalence of cancer induced bone pain is therefore likely to be much greater than the annual incidence.w1 Cancer induced bone pain is considered one of the most difficult pain conditions to treat because of its frequent association with weight bearing and movement. Not surprisingly, it has a major impact on patients’ daily functioning and mood and can result in admission to hospital.w2 w3

Sources and selection criteria

We searched Medline, Clinical Evidence, and the Cochrane Library using the terms “bone metastases”, “pain”, and “bone pain” and then combined these with the specific treatment terms individually. Where possible we have used systematic reviews but not referenced trials included in these reviews. We …

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