Manage Bone Pain From Non-Small-Cell Lung Cancer

When non-small-cell lung cancer spreads, bones are one of the most common places for it to go. It can be painful when this happens, but there are lot of treatments that bring relief and curb the growth of your disease.

Why It Hurts

Cancer cells release substances that damage your bones, making them weak and more likely to break. Weak or broken bones can be painful. Damaged bones can also hurt if they collapse and press on nerves.

In some people, bone pain is the first sign of cancer. The pain can get worse as the cancer grows.

Tests You May Get

If you feel pain in your bones, see the doctor who treats your cancer. They'll look for signs of cancer there with tests like these:

Bone scan. Your doctor injects a small amount of a radioactive substance called a tracer into a vein. Then, they take pictures of your bones. The tracer highlights areas of cancer on the images.

CT, or computed tomography. It's a powerful X-ray that makes detailed pictures of your bones.

MRI, or magnetic resonance imaging. It uses powerful magnets and radio waves to view structures in your body, such as your bones.

X-ray. It uses low doses of radiation to make pictures of your insides, including bones.

Cancer Treatments

Some of the same methods your doctor uses to treat cancer in your lungs can shrink tumors and relieve pain from cancer that has spread to your bones.

Chemotherapy. Chemotherapy uses drugs to stop the growth of cancer cells in your lungs, bones, and other parts of your body. You take this medicine by mouth or you get it through a vein.

This treatment shrinks tumors, which can lessen damage to your bones.

Some side effects you might get from chemotherapy are:

  • Hair loss
  • Fatigue
  • Bruising or bleeding more than usual
  • Nausea and vomiting
  • Infections
  • Changes in appetite
  • Constipation or diarrhea
  • Mouth sores

Radiation therapy. It uses high-energy rays to kill cancer cells or stop tumors from growing. It can strengthen your bones, make them less likely to break, and ease bone pain.

You'll get radiation from a machine outside your body. You could get some side effects, such as:

  • Irritation of the skin in the treated area
  • Fever and chills
  • Fatigue
  • Pain when you swallow (if you get radiation to the chest)


Treatments That Slow Breakdown of Your Bone

Bisphosphonates. These are drugs that slow bone loss. They work by stopping cells called osteoclasts from breaking down bone.

You may have heard that bisphosphonates treat the bone-thinning disease called osteoporosis. In cancer that has spread to the bones, these drugs can lessen bone loss, prevent fractures, and relieve pain.

You get bisphosphonates through an IV about once every 3 to 4 weeks.

Watch out for side effects that may include:

  • Tiredness
  • Fever
  • Nausea or vomiting
  • Appetite loss

Very rarely, bisphosphonates can cause a serious condition called osteonecrosis of the jaw (ONJ). ONJ cuts off the blood supply to part of the jawbone, which can cause infections there as well as mouth sores and tooth loss. Your doctor might recommend that you see a dentist for a checkup before you start this medicine.

Denosumab (Prolia, Xgeva). Denosumab is a type of drug called a monoclonal antibody. It blocks a substance called RANKL, which stops osteoclasts from breaking down bone.

You get denosumab as an injection under the skin every 4 weeks. It can help strengthen your bones and prevent fractures.

You might get side effects like these:

  • Nausea
  • Diarrhea
  • Tiredness
  • Weakness

This drug can also cause ONJ in rare cases. You may need to see a dentist before you start taking it.

Pain Relievers

These medicines won't stop bone damage, but they can help you feel better. Pain relievers that treat cancer bone pain include:

NSAIDs. Drugs such as aspirin and ibuprofen  can help with mild bone pain. They work by blocking substances called prostaglandins that make your bones hurt.

Opioids. Pain relievers like codeine, oxycodone, and tramadol help with more severe pain.

Gabapentin (Neurontin) and tricyclic antidepressants. These drugs can help give you relief if you also have nerve pain.

You can also get pain relief if you put heat or cold on the places that hurt.


Doctors can remove some or all of the tumor if it's pressing on your bone. They can also put in rods, screws, wires, or pins to keep the bone stable and prevent it from breaking.

If you have back pain, another option is a procedure called vertebroplasty. Your surgeon injects a special type of cement into your spine to keep the bones from collapsing.

WebMD Medical Reference



American Cancer Society: "Chemotherapy Side Effects," "External Radiation Side Effects Worksheet," "Treating Bone Metastases."

American College of Rheumatology: "Bisphosphonate Therapy."

Cancer Research UK: "Bisphosphonates and cancer," "Radiotherapy for Bone Pain."

Journal of Thoracic Oncology: "Effect of bisphosphonates, denosumab, and radioisotopes on bone pain and quality of life in patients with non-small cell lung cancer and bone metastases: A systematic review."

Mayo Clinic: "Bone metastasis: Diagnosis & treatment," "Bone metastasis: Symptoms & causes."

National Cancer Institute: "Non-Small Cell Lung Cancer Treatment (PDQ)-Patient Version."

Therapeutic Advances in Medical Oncology: "Bone and brain metastasis in lung cancer: recent advances in therapeutic strategies."

University of Rochester Medical Center: "Bone Metastases: When Cancer Spreads to Bones."

UpToDate: "Patient education: Non-small cell lung cancer treatment; stage IV cancer (Beyond the Basics)."

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