Antalgic treatment of pain associated with bone metastases

Pain from metastases of primitive cancer is the first sympthom of disease i n 15-20% of patients and remains the most common cause of cancer-related pa in, 30-70% of patients have metastases at diagnosis, and 80% of them at the moment of death. Functional impairment of skeleton, neurologic symptoms, p athological fractures and pain are the most important indications for palli ative treatment which should result in tumor regression, relief in cancer-r elated symptoms and maintainance of functional integrity. Bone metastases a re treated with the systemic therapies including radiotherapy, hormonal man ipulation, biphosphonates, calcitonin. surgical treatment, and chemotherapy . Conventional use of opioids or non-steroidal anti-inflammatory drugs does not always produce satifactory analgesic result in treated patients becaus e of incidental and intermittent nature of pain and unacceptable side effec ts. Alternative strategies (peripheric and central nerve blocks, neurolysis ) are frequently required. A proper use of different modalities of treatmen t enhances the probability of achieving relief of pain and maintaining an a cceptable quality of life. (C) 2001 Elsevier Science Ireland Ltd. All right s reserved.