Palliative radiotherapy plus multimodal analgesia for painful bone metastases: improved pain control and survival

To evaluate the synergistic effects of palliative radiotherapy combined with multimodal analgesia on pain control, quality of life, and survival in patients with painful bone metastases, and to identify prognostic factors for overall pain response.

This retrospective study analyzed 205 patients with radiologically confirmed painful bone metastases treated at West China Fourth Hospital (2015-2022). Patients were divided into a control group (n = 103; conventional palliative care with clinician-directed analgesia) and an observation group (n = 102; protocolized multimodal analgesia plus palliative radiotherapy to symptomatic lesions). The primary outcome was overall pain response at week 12, assessed using consensus numeric rating scale (NRS)-opioid criteria. Secondary outcomes included longitudinal NRS scores, pain relief duration and onset, quality of life, safety, progression-free survival (PFS) and overall survival (OS).

The observation group achieved greater reductions in NRS pain scores at all time points (all P < 0.001), with longer pain control duration and more rapid onset of relief (both P < 0.001). Greater improvements in global health and functional domains were observed at week 12 (all P < 0.001). Overall and grade 3-4 adverse event rates were comparable between groups, though constipation was less frequent in the observation group (29.4% vs 42.7%, P = 0.047). The observation group showed longer PFS (7.2 vs 4.8 months; hazard ratio [HR] 0.68, P = 0.009) and OS (12.1 vs 9.4 months; HR 0.73, P = 0.021), greater improvements in inflammatory and nutritional markers (all P < 0.001), and higher odds of overall pain response (odds ratio 0.116, P < 0.001).

Palliative radiotherapy combined with multimodal analgesia provided superior pain control, improved quality of life, and prolonged survival compared to standard care, without increased serious toxicity, in patients with painful bone metastases.