Korean J Pain.  2013 Jul;26(3):223-241. 10.3344/kjp.2013.26.3.223.

Painful Boney Metastases

• Smith HS
• Mohsin I

• KMID: 2074023
• DOI: http://doi.org/10.3344/kjp.2013.26.3.223

Abstract

Boney metastasis may lead to terrible suffering from debilitating pain. The most likely malignancies that spread to bone are prostate, breast, and lung. Painful osseous metastases are typically associated with multiple episodes of breakthrough pain which may occur with activities of daily living, weight bearing, lifting, coughing, and sneezing. Almost half of these breakthrough pain episodes are rapid in onset and short in duration and 44% of episodes are unpredictable. Treatment strategies include: analgesic approaches with "triple opioid therapy", bisphosphonates, chemotherapeutic agents, hormonal therapy, interventional and surgical approaches, steroids, radiation (external beam radiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation, cryoablation), and intrathecal analgesics.

Keyword

boney metastases; breakthrough; cancer; pain; triple opioid therapy

MeSH Terms

Activities of Daily Living
Analgesics
Breakthrough Pain
Breast
Cough
Diphosphonates
Lifting
Lung
Neoplasm Metastasis
Prostate
Sneezing
Steroids
Stress, Psychological
Weight-Bearing
Analgesics
Diphosphonates
Steroids

Figure

• 

  Fig. 1 The spectrum of metastatic bone disease.

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  Fig. 2 Osteoclastic bone resorption.

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  Fig. 3 Schematic of c-Src and other nociceptive signaling pathways in painful osseous metastases.

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  Fig. 4 Two different types of breakthrough pain (BTPs) and their "matching" opioid treatment. CRO: controlled release opioid, GOBTP: gradual onset breakthrough pain, IRO: immediate release opioid, ROBTP: rapid onset breakthrough pain, ROO: rapid onset opioid.

• 

  Fig. 5 Intrathecal analgesic therapies.

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