Managing Cancer Pain from Bone Metastasis
Bone Metastasis: What Treatment Is Best for You?
Your doctor will consider many factors when determining your treatment options. One is the location of the pain. For example, metastasis in a weight-bearing bone is more painful than in other bones, Fasano says. This may affect the approach to treatment.
Pain management may also depend on how widespread the pain is. "If pain is focal -- meaning just in one place -- we would manage that somewhat differently than if it is in multiple places," Gralow tells WebMD.
If you have pain only in one or two spots, it is possible to target the cancer with radiation therapy. This uses high-energy X-rays to kill cancer cells and help relieve bone pain. Often, though, the pain is in several spots, Gralow says. It is not possible to focus a directed therapy such as radiation on many spots. "So we have to use a more total body treatment for the pain, such as drug therapy."
Treatments to Relieve Bone Metastasis Pain
From simple pain medications to orthopaedic procedures to radiation therapy, a wide range of options can help control pain. And, of course, it is always important to get the disease under control with whole-body therapies, Gralow says. This might include chemotherapy, hormone therapy, or other cancer treatments.
Other commonly used treatments specifically for bone mets include:
Pain medication. This may range from nonsteroidal anti-inflammatories to steroids or narcotics, Fasano says. In some cases, other types of drugs can also treat pain. For example, sometimes a bone fracture causes a vertebra to collapse, and this can pinch a nerve. An MRI (magnetic resonance imaging), along with your description of the pain, can help your doctor tell if this is the cause. If it is, a drug that targets nerve-related pain can help.
Radiation therapy. This is most helpful if bone metastasis is limited. With external beam radiation, a machine outside the body focuses a beam of radiation on the bone metastasis. It lasts only a few minutes. You may receive radiation in one large dose or in smaller doses over several treatments. In cases when cancer has spread to many different areas of bone, radiopharmaceuticals may be helpful. These drugs are given in a single injection and target the bone areas that have the mets. They release radiation that kills cancer cells and helps curb pain.
Bisphosphonates (Aredia and Zometa). These bone-strengthening drugs were first used for osteoporosis. Now doctors also use them to prevent and treat skeletal problems from bone metastases. They decrease pain while reducing bone damage and risk for fracture. They also lower blood levels of calcium that may be too high. They are usually given to cancer patients by intravenous (IV) infusion.
Denosumab (Xgeva). "We also have a new class of drugs we can use to help prevent bone breakdown and help with pain," Gralow says. Denosumab is injected under the skin, rather than by infusion. However, it's more expensive than bisphosphonates, so some insurance companies will pay for it only after you've first tried a bisphosphonate.
Vertebroplasty. When the spine becomes weakened from cancer, the vertebrae can collapse. A specialist can do a vertebroplasty to fill the space and relieve pressure. "This technique was originally developed for fractures from osteoporosis," Gralow says. The specialist injects bone cement into the fractured vertebra. It hardens quickly and can prevent further collapse. Vertebroplasty can help restore mobility and improve back pain within hours.
Orthopaedic surgery. If a bone breaks and causes pain, surgery may help. The surgeon may insert a device such as a screw, rod, or plate to stabilize bone.
Ablation Treatments. With this technique, a probe is directly inserted into a tumor and heat, cold, electric current, or a chemical is used to kill cancer cells.