Management of Bone Pain Secondary to Metastatic Disease.

Metastatic involvement of the bone is one of the most common causes of pain in cancer patients. Of the estimated 1.4 million patients who will be newly diagnosed with cancer in the United States this year, 30% to 70% will develop skeletal metastases.2,3 The most common primary malignancies that metastasize to the bone are breast, kidney, lung, and prostate (Table 1). The most common sites of metastasis are the vertebrae, pelvis, and long bones (Table 2). Pain is the most frequent symptom of bone metastases and develops gradually over weeks to months, becoming progressively more severe. Pain combined with other complications (eg, hypercalcemia, pathologic fracture, nerve root compression, spinal cord compression, focal neurologic deficits, and forced immobilization) can lead to a decrease in patients’ quality of life.2 Palliation of symptoms can result in significant restoration of quality of life for these patients. Such palliation measures, when possible, should avoid additional discomfort to patients and be cost effective and simple to administer. The proposed algorithm on page 157 outlines such an approach, with special emphasis on the multidisciplinary team effort.