Treatment. Bone pain

Bone pain diagnosis

Bone pain can be difficult to distinguish from other types of back pain, such as that due to arthritis or degenerative disc disease. Often, the pain caused by bone metastasis is present most of the time, rather than occurring only at intervals.

Cancer that has initially developed in another part of the body and spread to the bone is metastatic bone cancer or bone metastases.

Doctors may use X-rays to rule out other causes of bone pain, such as broken bones (fractures) or osteoarthritis, but a bone scan may be recommended if no other condition is found to explain bone pain. To perform a bone scan, special radiopaque dye is injected into a vein, and some of this collects in bone tissues. Areas of bone damage and cancer growth attract particles in the dye, and these areas are revealed on the images to confirm the presence of cancer.

Metastatic bone cancer can be found in any one of the skeletons, but it is most commonly found in the following sites:

• The ribs
• The pelvis
• The upper leg (femur)
• The skull
• The upper arm (the humerus)
• The back (the vertebrae)

When bone cancer is suspected, your healthcare provider will want to discuss your medical and family history with you. Then, a thorough physical examination will be completed, as well as diagnostic testing. Noncancerous tumors, infections, and other medical conditions can sometimes produce symptoms similar to bone cancer, so extensive studies may be recommended to make an accurate and complete diagnosis.

Laboratory Testing

• Blood tests: Looking at specific components in your blood helps in the diagnosis of bone cancer. Blood tests cannot diagnose bone cancer on their own, but they can help rule out other causes of your symptoms.
• Biopsy: A biopsy of tissue can determine whether cancer cells are present. A biopsy is a small sample of tissue that is removed and then examined under a microscope for the presence of cancer cells. There are several different types of biopsies:
  • Excisional biopsy: This involves the removal of an entire tumor at the same time the tissue is being obtained for biopsy. Some tumors are too large to be removed at the time of biopsy.
  • Open biopsy: This involves making a small incision in the skin to remove a small section of the tumor.
  • Needle biopsy: In this type of biopsy, a needle is inserted through the skin into a tumor, and tissue is removed using the needle and a syringe.

Imaging Studies

Imaging studies may be used when bone cancer is first diagnosed and during cancer treatment to monitor the effect of the treatment and look for evidence that bone cancer has spread to other areas of the body.

• X-rays
• Bone scan
• MRI or CT scan
• PET scan

Bone pain treatment

After your healthcare provider determines the cause of your condition, the appropriate treatment for bone pain can be recommended. Depending on what’s causing your pain, treatment may include one or a combination of any of the following options:

• Pain medications: Analgesics or pain pills are often recommended, and they can help relieve your symptoms, however, they won’t cure the underlying problem that is causing bone pain.
• Antibiotics: If your bone pain is due to an infection, antibiotics will be needed, in addition to pain relievers. These may need to be given into a vein (IV), and they often need to be taken for several weeks.
• Surgery: Depending on the cause, you may need surgery to remove an infection in your bone completely or to remove tissues that have died because of the damage infection has caused.
• Nutritional supplements: If the cause of your bone pain is severe osteoporosis, your healthcare provider may recommend vitamin D and calcium supplements to maintain healthy levels of these essential nutrients.

Treatment for bone pain due to cancer  

Treatment of one pain due to cancer can be performed by treating underlying cancer. These treatment methods may include surgery to remove cancer if possible, radiation treatments, chemotherapy, surgery, and medication for bone pain. For example, bisphosphonates are sometimes used in the treatment of metastatic bone cancer. These drugs help prevent damage to bones and can help prevent bone pain.
Treatment for bone pain due to bone metastases focuses on the following goals:

• Providing effective pain relief
• Treating fractures
• Preventing bone injuries and other complications

Medications for bone pain caused by cancer

Bone pain due to cancer is a real concern for those diagnosed with metastatic disease, especially if they are living at home. The severity of a patient’s pain usually dictates what kind of medication for pain is used.

• Mild to moderate pain: For this type of pain, non-narcotics are typically the first treatment choice. Examples of mild non-narcotic analgesics are acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen. 
• Moderate to severe pain: When bone pain due to cancer is not relieved by first-step analgesics, narcotics should be used. Examples of these include hydrocodone, oxycodone, codeine, tramadol, and propoxyphene. These medications may be given in combination with an NSAID or acetaminophen.
• Severe pain: Patients with severe pain or those whose pain has not been relieved by first-line narcotics should be given a stronger opioid. Examples of narcotics for severe pain include morphine, hydromorphone, fentanyl, methadone, or levorphanol. Non-narcotic medications can also be added to these opioids.

Powerful medications for bone pain have side effects that often include:

• Sleepiness or sedation
• Dizziness
• Nausea or vomiting
• Constipation

Radiation therapy for bone cancer

When there is no risk of immediate bone fractures, radiation is sometimes used to relieve bone pain and limit the progression of cancer. It is especially beneficial when the cancerous lesions are only found in one specific area.
Radiopharmaceutical therapy is a type of radiation treatment that involves injections of radioactive material into the body through a vein. The injected material is drawn to the sites of cancer within the bone. Directly treating the site of cancer with radiation in this way can be beneficial in relieving pain by destroying active cancer cells. A possible side effect of this treatment is an increased risk of bleeding. In rare cases, leukemia may also be a side effect of radiopharmaceutical therapy.

Surgery for bone cancer

If there is an increased risk of bone fracture due to bone cancer, it may be necessary to perform surgery to stabilize the weakened bone. Metal instrumentation, such as surgical plates, rods, wires, or pins, can be inserted to provide structure and strengthen a bone damaged by cancer.