Pain Management in Metastatic Bone Disease

Pain is a complex phenomenon that has physical, psychological, and emotional factors that can alter activities of daily living, as well as quality of life. Pain serves as an alarm system, signifying injury, drawing the patient’s attention to the affected area of the body. Prompt attention and treatment of pain can often mitigate or lessen the development of chronic pain. Although pain has been considered a symptom, there is a growing understanding that chronic pain functionally changes the central nervous system in plastic fashion. The neuroplastic change is often pathologic and begs the provocative question, when does the symptom become the disease itself? With the growing incidence of cancer cases, coupled with prolonged survival of patients secondary to effective chemotherapeutics, surgical technique and targeted therapies, the prevalence of patients with bone metastases is notably increasing. The management of bone pain secondary to metastases can require a multidisciplinary and multimodal approach with several specific treatments. The choice of a specific treatment or treatments are carefully weighed, formulating a sophisticated risk/benefit analysis prior to implementation.