Managing Pain

If there's one thing synonymous with bone metastases, it's pain.

Pain is usually the first sign of something wrong and the single most overriding daily concern for people with bone metastases.

According to a study by the Yale Cancer Center, 83 percent of patients with metastatic bone disease had some kind of pain. Of those people, half had movement-related pain or pain that occurred spontaneously. For these people, the pain lasted up to 30 minutes at a time. Onset and duration of this type of pain is often unpredictable.

While the pain can come and go, it can be more prominent in the pelvis, spine, and the long bones of the arms and legs because those are often where cancer cells spread and form tumors. The pain is often worst at night or after long periods of rest.

Along with regular pain, metastasis also weakens the bones, leaving them prone to breakage. Bone metastases are often discovered only after a bone break with minimal impact or trauma.

Common cancers such as those of the breast, lung, and prostate cause the majority of bone metastasis. Kidney and thyroid cancers also often cause bone problems.

Caring for bone metastasis and its pain involves a team approach. Patients should work with an oncologist, radiologist, and often a surgeon familiar with cancer in bones. This multimodal approach not only treats the cancer, but also seeks to alleviate pain.

Common treatments for pain associated with bone metastasis include:

  • External beam radiation: These high-energy x-rays target a tumor site, often sparing healthy tissue around it. It is used in bone metastasis to attack the deposits of cancer cells in specific areas of the body. The procedure is painless.
  • Bisphosphonates: This class of drugs is designed to prevent the loss of bone mass and density. They work by binding with calcium to slow down the degenerative process of bone metastasis.
  • Opioid analgesics: The most powerful of pain relievers, these narcotics are used for several types of short-term pain, especially after surgeries and broken bones. These are the preferred type of pain relievers because of their effectiveness. However, they can be habit-forming.
  • Systemic chemotherapy: Chemotherapy is often used in treating most types of cancer. While radiation can be targeted, chemotherapy affects all cancer cells throughout the body. Chemotherapy not only affects the source of the cancer, but the metastasis as well.
  • Radionuclide therapy: This type of radiation therapy is sometimes used because of its ability to target selective key areas, thus lowering dangerous side effects.
  • Over-the-counter pain medication: Non-steroidal anti-inflammatory agents (NSAIDs) such as ibuprofen and naproxen — the main base ingredient for many OTC medicines — are often used to treat bone pain. There are some claims that NSAIDs can also slow bone degeneration, but substantial research is lacking. There are several more potent NSAIDs that are given by prescription that can reduce the pain caused by inflammation around areas of bone metastases.
  • Homeopathic treatments: Alternative treatments for bone pain could include acupuncture, certain exercises, Epsom salt baths, and other treatments.

With bone metastasis and all cancer treatments, make sure to discuss all options with your doctor. Do not discontinue any on-going treatment, or begin a new one, without consulting your primary doctor first.