Painful Osseous Metastases

Up to 90% of patients with metastatic or advanced stage cancer will experiencesignificant cancer-related pain. Approximately half or more of patients diagnosed withcancer may experience bone pain. It has been estimated that tumor metastases tothe skeleton affect roughly 400,000 United States citizens annually. Carcinoma frombreast, lung, and prostate cancers account for about 80% of secondary metastaticbone disease. Bone metastases may cause devastating clinical complications associatedwith dramatic reductions in quality of life, mobility, and independence as well asexcruciating refractory pain. Associated complications from osseous metastases alsopresent a substantial economic burden. Currently, there is still a significantly highnumber of patients suffering with unrelieved pain from osseous metastases.Treatments for painful osseous metastases may not only diminish pain, but may alsoimprove quality of life and independence/mobility, and reduce skeletal morbidity,potential pathologic fractures, spinal cord compression, and other “skeletalrelated events.” Treatment strategies for painful osseous metastases includesystemic analgesics, intrathecal analgesics, glucocorticoids, radiation (external beamradiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation(RFA) and cryoablation), bisphosphonates, chemotherapeutic agents, inhibitors ofRANK-RANKL interaction (e.g., denosumab), hormonal therapies, interventionaltechniques (e.g., kyphoplasty), and surgical approaches. Although the mechanismsunderlying the development of bone metastases are not completely understood,there appears to be important bi-directional interactions between the tumor and thebone microenvironment. A greater understanding of the pathophysiology of painfulosseous metastases may lead to better and more selective targeted analgesic therapy.Additionally, potential future therapeutic approaches to painful osseous metastasesmay revolutionize approaches to analgesia for this condition, leading to optimaloutcomes with maximal pain relief and minimal adverse effects.Key words: Cancer pain, metastasis, osseous metastasis, bone pain, radiationtherapy, radiopharmaceuticals