Research Review: Bone Pain in Cancer
This paper discusses the mechanisms involved in bone pain during cancer and reviews the recommended treatment methods.
Renata Zajaczkowska et al. Bone Pain in Cancer Patients: Mechanisms and Current Treatment. Int. J. Mol. Sci. 2019, 20, 6047; doi:10.3390/ijms20236047
Key Points: Bone Pain in Cancer
The location of metastatic bone lesions and their severity does not always correlate with the severity of pain experienced by cancer patients.
In 20% of patients, a pathological bone fracture or pain constitutes the first symptom of cancer.
The intensity of bone pain in cancer patients cannot be predicted by the tumor type or size, the number of metastases, or the bone involvement.
The intensity of pain generally intensifies during movement.
Bone pain in cancer patients involves complex interactions between bone cells, tumor cells, activated inflammatory cells, and neurons innervating the bone.
Cancer pain includes neuropathic and inflammatory processes modified at the level of peripheral nerves and tissues, as well as the central nervous system (brain and spinal cord).
Physiological remodeling of bones relies on the balance between osteoblast activity and bone resorption by osteoclasts.
Bone metastases depend on the interaction between tumor cells, bone matrix cells, and nerve fibers innervating the bones.
Tumor cells do not cause direct damage to the bones. Instead, they activate the receptor activator for nuclear factor kappa B system.
Radiotherapy reduces the risk of pathological fractures or metastatic spinal cord compression.
External beam radiotherapy or radioisotope treatment should be considered for all patients with bone metastases.
External beam radiotherapy is the first line treatment for the majority of patients with metastatic spinal cord compression because of its pain-relieving effect.
There is no optimal surgery for spinal metastases. However, posterolateral fusion with autologous bone grafting is widely used.
The goal of therapy is not only to relieve pain, but to also prevent the progression of pain and skeletal-related events.
Treatment of bone pain in cancer should be multimodal (symptomatic analgesic treatment, causal treatment, pharmacological, and non-pharmacological treatments).
Treatments for bone pain should be individualized and targeted at pain relief, increasing patient function, improve quality of life, and prolong survival (where possible).
Clinical Pilates in practice
There is considerable literature to support exercise for pain relief in all populations, including cancer (not discussed here).
Because pain is not necessarily triggered through mechanical stimuli with this population, it is important to be open to communication, and assess pain and function on a daily basis.
Ensure intensity, load, and impact are appropriate, especially if working with pathological fractures.
Maintain function and build strength within ranges of motion that are pain-free or tolerable.
Work with clients to offload painful sites, and decompress painful areas to maintain secondary function.