Treatments

Pain management for bone metastases has multiple options for the health care team to draw upon. The primary treatment for the majority of patients is external beam radiotherapy, either localized or wide field. These treatments provide excellent relief of the bone pain. Localized radiation treatments target specific sites for pain relief and the promotion of healing and prevention of fractures. Spinal cord compression from vertebral collapse requires immediate and localized radiation therapy, possibly in conjunction with surgical intervention to prevent paralysis or loss of life. Wide-field radiation therapy treats multiple disease sites and is appropriate for more diffuse bone pain. One half of the body receives radiation in a single treatment. Studies report relief of the bone pain in 55-100% of patients. Analgesics (pain relievers) are typically given in conjunction with radiotherapy. Severity of the bone pain and general health of the patient will determine the prescribed medication. The spectrum of medications prescribed range from over-the-counter pain medication to opioids for extreme bone pain management.

Radiopharmaceuticals may be an effective choice for bone pain management. Iodine-131 is used in the treatment of multiple bone metastases from thyroid cancer. Phosphorus-32 orthophosphate has a success rate of about 80% in bone pain management in patients suffering with breast and prostate cancer. Strontium-89 provides partial or complete pain relief in approximately 65% of patients. Other radiopharmaceuticals are being tested internationally but have not yet received FDA approval for use in the United States. In treatments for bone resorption-induced pain, a group of chemical agents, known as bisphosphonates and calcitonin, acts to strongly block the bone resorption process. These agents are used in the management of hypercalcemia and have the added effect of reducing the prescribed amount of analgesics and shortening the duration of bone pain.

Alternative and complementary therapies

Comprehensive management of bone pain includes non-clinical choices. Patients should be encouraged to participate in complementary therapies, and some patients may choose to investigate more alternative therapies. More conventional complementary therapies may include relaxation and imagery therapy, cognitive distraction and reframing, support group and pastoral counseling, skin stimulation, biofeedback, nerve blocks, immobilization and stabilization techniques, and surgical intervention. Less well-defined alternative therapies may include acupuncture, body massage with pressure and vibration techniques, hypnosis, menthol preparations, and holistic or herbal medical practices. No conclusive data exist of the effectiveness of these therapies used alone; however, in conjunction with conventional methods of bone pain management, they do not appear to hinder therapy and may provide the patient with increased goodwill and a positive outlook.

Resources

PERIODICALS

Coleman, Robert E. "Management of Bone Metastases." The Oncologist 5 (September 2000): 463-470.

Jane Taylor-Jones, M.S., Research Associate

Author Info: Jane Taylor-Jones M.S., Research Associate, The Gale Group Inc., Gale, Detroit, 2002