Cancer-related pain and its pharmacologic management in the patient with bone metastasis.

Cancer pain most commonly occurs in patients with locally advanced or metastatic disease. Certain characteristics of cancer-related pain, including its multifocal nature, severity, heterogeneity, progressive nature, and other special challenges, distinguish it from most other types of chronic pain. Bone metastases are the most common cause of pain in patients with malignant disease, in part due to the high frequency of axial (vertebrae, rib, and pelvis) and appendicular (femoral and humeral) fractures. Relief begins with a thorough understanding of the extent of the disease and the risks of associated complications, such as spinal cord compression. Pharmacologic approaches to pain treatment include acetaminophen, anti-inflammatory agents, opiates, and bisphosphonates. As new investigational treatments continue to develop, clinicians must continue to rely on skilled assessment techniques and an understanding of the many causes of cancer-related pain to effectively diagnose and treat pain caused by bone metastasis.