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Management of painful bone metastases
Sebastiano Mercadante1, Fabio Fulfaro
1Anesthesia & Intensive Care Unit - La Maddalena Cancer Center, University of Palermo, Palermo, Italy. terapiadeldolore@la-maddalena.it
Current Opinion in Oncology
|June 5, 2007
Summary
Bone pain has a unique pathophysiology, requiring multidisciplinary treatments beyond traditional analgesics. Effective management combines therapies like radiotherapy, chemotherapy, and supportive care for improved patient outcomes.
Area of Science:
- Oncology
- Pain Medicine
- Pharmacology
Background:
- Bone pain presents unique pathophysiological mechanisms distinct from inflammatory pain.
- Cancerous bone destruction triggers neurochemical changes in the spinal cord.
- These changes necessitate higher opioid doses compared to inflammatory pain models.
Purpose of the Study:
- To review recent data on bone pain pathophysiology and mechanisms.
- To highlight the importance of multidisciplinary treatment approaches.
- To contrast traditional analgesic use with comprehensive therapeutic strategies.
Main Methods:
- Review of recent experimental (animal) models of bone pain.
- Analysis of neurochemical changes in spinal cord segments associated with bone destruction.
- Evaluation of various pharmacological and non-pharmacological interventions.
Main Results:
- Bone pain pathophysiology involves unique neurochemical alterations in the spinal cord.
- Opioid requirements for bone pain exceed those for inflammatory pain of similar intensity.
- Preclinical data supports the efficacy of multiple therapeutic agents.
Conclusions:
- Multidisciplinary treatment is essential for bone cancer pain, integrating radiotherapy, systemic therapies (hormone/chemotherapy), and supportive care (analgesics, bisphosphonates).
- Radioisotopes and minimally invasive techniques may benefit selected cases of metastatic bone pain.
- Individualized treatment plans considering patient condition, prognosis, and quality of life are crucial.
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