Cancer induced bone pain

• Published in: BMJ (Online) Vol. 350; no. jan29 7; p. h315
• Main Authors: Kane, Christopher M, Hoskin, Peter, Bennett, Michael I
• Format: Journal Article Book Review
• Language: English
• Published: England British Medical Journal Publishing Group 29-01-2015; BMJ Publishing Group LTD
• Subjects: Analgesics, Opioid - therapeutic use; Antibiotics; Antibodies, Monoclonal, Humanized - therapeutic use; Bone Density Conservation Agents - therapeutic use; Bone Diseases - etiology; Bone Diseases - prevention & control; Bone Neoplasms - complications; Bone Neoplasms - secondary; Bone Neoplasms - therapy; Bones; Cancer; Cancer therapies; Chemotherapy, Adjuvant - methods; CLINICAL REVIEW; Complementary Therapies - methods; Denosumab; Diphosphonates - therapeutic use; Humans; Ligands; Metastasis; Narcotics; Pain; Pain - etiology; Pain - prevention & control; Patient Education as Topic; Referral and Consultation; Spinal cord
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.h315

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 30000 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. [...]in patients with or without active cancer, persistent pain in these areas should alert clinicians to the possibility of bone metastases.