CAUSES AND TREATMENT OF BONE PAIN OF MALIGNANT ORIGIN

Pain relief has been one of the oldest and most important duties of th e physician. There has been little change with regard to this obligati on of all caregivers. One-third of patients with advanced cancer will develop clinically relevant skeletal metastases and chronic pain durin g the course of their disease. All physicians involved in the treatmen t of cancer patients should know the basic principles of pain treatmen t. These are described in the following article with special regard to bone pain of malignant origin. Correct assessment of pain intensity a nd frequency, as well as of the probable causes of pain, and the admin istration of adequate analgesic treatment should achieve satisfactory results in the vast majority of patients. Every physician should obtai n derailed knowledge of the indications and adequate administration of pain-killing therapy as well as possible adverse effects and their su ccessful treatment. It is important in particular to concentrate on a few nonsteroidal anti-inflammatory drugs (NSAIDs) as well as opiates. Knowledge of adequate doses, maximal recommended daily doses, pharmaco logical properties, important adverse effects and interactions is esse ntial for success in the daily routine. Only by selecting 2 or 3 drugs from each step in the analgesic ladder (WHO) will the nonspecialised physician obtain sufficient experience for optimal analgesia. Physicia ns should also not hesitate to contact other specialists (medical onco logists, radiotherapists, neurosurgeons, anaesthesiologists and others ) in order to maximise benefit for an individual patient.