Managing Cancer Pain from Bone Metastasis

Treatments to Relieve Bone Metastasis Pain continued...

• 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.
• Focused Ultrasound (FUS). Non-invasive and radiation free, an ultrasound beam is used to heat the targeted bone and bone tissue where the pain is occurring, changing or destroying the tissue.
• 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.