Using bisphosphonates to control the pain of bone metastases: evidence-based guidelines for palliative care

This work was undertaken by the Science Committee of the Association for Pa lliative Medicine of Great Britain and ireland (APM) as a demonstration pro ject in developing clinical guidelines relevant to palliative care from a p ragmatic approach to literature review and grading of clinical evidence. CA NCERLIT and Embase were searched for relevant papers written in English, pu blished since 1980. Each study identified was rated against agreed criteria for levels of evidence. Most studies were not specifically designed to def ine speed of response, and were not undertaken in palliative care patients. Thus, careful reading and grading of each study was necessary. Sufficient evidence was identified to make recommendations for clinical practice in a palliative care population of patients, and areas for future research have been identified. Bisphosphonates appear to have a role in managing pain fro m metastases which has been refractory to conventional analgesic management and where oncological or orthopaedic intervention is delayed or inappropri ate.