Looking Beyond the Usual Medications for Treatment of Cancer-Related Bone Pain

Background Bone pain related to metastases is common among individuals who develop cancer later in life and can be debilitating. Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids are typically used to treat this type of pain. However, many patients have comorbidities, allergies, or adverse reactions that limit the use of one or more of these types of medications. Objective The objective of this review is to explore alternative medications that could be effective in treating older individuals with cancer-related bone pain while minimizing adverse effects. Data Sources The authors conducted a literature search in PubMed using "bone pain" and "medications" in the Title/Abstract field with no exclusions. After excluding articles that focused on non-cancer bone pain, those not in English, or involved animal studies, twelve articles published between 2004 and 2024 were included for analysis. Data Synthesis Several potentially useful therapies were discussed or evaluated in the articles used in the review. These include bisphosphonates, antihistamines, denosumab, antidepressants, anticonvulsants, corticosteroids, ketamine, and cannabinoids. Discussion Bisphosphonates and denosumab were found to be more effective at preventing bone pain than treating it. Antihistamines were associated with reduced bone pain in patients treated with granulocyte-colony stimulating factor (G-CSF). Antidepressants and anticonvulsants showed an improvement in bone pain with a neuropathic element. Conclusion Several alternative therapies for cancer-related bone pain were identified. However, more research is needed to determine which options are more effective for patients who cannot use or are not getting relief from standard medications.