Article Abstract

Painful boney metastases

Authors: Howard S. Smith


Treatments for painful osseous metastases may not only diminish pain, but also may improve quality of life and
independence/mobility, and reduce skeletal morbidity, potential pathologic fractures, spinal cord compression, and other
"skeletal-related events". Treatment strategies for painful osseous metastases include: Systemic analgesics, intrathecal
analgesics, glucocorticoids, radiation (external beam radiation, radiopharmaceuticals), ablative techniques [radiofrequency
ablation (RFA) and cryoablation], bisphosphonates, chemotherapeutic agents, inhibitors of RANKL-RANK interaction
(e.g., denosumab), hormonal therapies, interventional techniques (e.g., kyphoplasty), and surgical approaches. The
mechanisms underlying the development of bone metastases remain incompletely understood. A greater understanding
of the pathophysiology of painful osseous metastases may lead to improved and more selective targeted analgesic therapy.
Additionally, potential future therapeutic approaches to painful osseous metastases may revolutionize approaches to
analgesia for this condition, leading to optimal outcomes with maximal pain relief and minimal adverse effects.