If you have cancer that has spread to the bone, you will surely have pain – Bone cancer – Bone metastasis. It may be right at the place where the cancer has reached and in areas surrounding it. It may be worse at night and when you rest, or it may be better when you rest and worse with movement.

No matter how pain behaves, it is the most common complaint of people with bone metastasis.

Understanding and Tracking Bone Metastasis Pain

Metastatic cancer cells damage bones and cause pain several ways:

• They produce substances that can dissolve and weaken bones. This may cause a bone to break, which is painful.
• As the tumor grows in the bone, nerve endings in and around the bone also send pain signals to the brain.
• They may make bones harden. This is called sclerosis.

For the Best Pain Relief, Keep a Diary

If you have bone metastasis, you can help us in treating the pain by keeping track of it. “A really clear understanding of the pain is going to help the most,”

It is strongly advisable; to keep a pain diary so that you can answer questions your Pain specialist doctor may ask, like:

• When is your pain the best and worst — for example, with movement or when lying down?
• How severe is the pain on a scale of 1 to 10?
• What is the pain like? Is it burning? Sharp? Dull?
• Where is the pain located? In one place? In several places?

Bone Cancer and Bone Metastasis

What Treatment Is Best for You?

Your doctor will consider many factors when determining your treatment options. One is the location of the pain. For example, metastasis in a weight-bearing bone (spine, legs, pelvis etc) is more painful than in other bones (shoulder).

If you have pain only in one or two spots, it is possible to target the cancer with ‘Interventional targeted pain treatment’. Often, though, the pain is in several spots. It is not possible to perform the pain treatment on multiple spots. So we have to use a more total body treatment for the pain, known as “pain implants”.

Interventional Targeted Pain Management

Vertebroplasty

When the spine becomes weakened from cancer, the vertebrae can collapse. Vertebra is full of soft tumour tissue causing severe pain and starts collapsing leading to compression or fractures in spine. A pain specialist doctor can do a vertebroplasty to fill the space and relieve pressure. The pain specialist puts medicated bone cement into the vertebra with the help of needle like instruments after making a small area numb on the back. It hardens quickly and can prevent further collapse. Vertebroplasty can help restore mobility and improve back pain within hours.

Cementoplasty

Cementoplasty is a nonsurgical procedure of putting medicated bone cement into bone tumours or bone metastases, mainly in those areas which are outside spine. Its main purpose is to stabilise the bone and to control pain. It can be done in the bones of pelvis, legs and arms. It surely helps in reducing the risk of fractures. This procedure is done with the help of x-rays or CT scan. A probe is placed inside the target bone without any cut or incision.

The term cement is used to describe a wide variety of viscous materials that can be used for consolidation of painful bony metastasis. The cement contains a substance that allows the pain specialist doctor to follow what is happening using an X-ray technique called fluoroscopy.

Balloon Kyphoplasty

How is balloon kyphoplasty different from vertebroplasty?

Kyphoplasty and vertebroplasty are actually quite similar. Both minimally invasive procedures use medicated bone cement to stabilize bone or spinal fractures. They also each use thin tubes (called cannulas) that are inserted into each vertebra through few mm hole to inject the cement

The main difference is that kyphoplasty has a small balloon inserted into the bone tumour or bone metastasis.  The balloon is inflated to create a space that the doctor later fills with bone cement. This extra feature allows kyphoplasty to help restore vertebral height, and thus, help reduce spinal deformity.  It also allows a thicker cement to be used which has less risk of leaking out and causing complications.

How long does balloon kyphoplasty take?

Balloon kyphoplasty usually takes about a half hour per level. Hospital stays are short—most patients are discharged within 24 hours of their treatment.

What are the benefits of kyphoplasty?

• Improvement in mobility
• Reduction in the number of days the patient stays in bed
• A low complication rate
• Improvement in quality of life
• Significant reduction of back pain
• Improvement of performing daily activities

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.

Radiofrequency ablation (RFA) is a common type. It uses a probe that carries an electric current. The tip of the probe is put into the bone tumor. X-ray or CT scans may be used to be sure the probe is in the right place. An electric current is then sent through the needle to heats the tumor to destroy it.

In another type of ablation, called cryoablation, a very cold probe is put into the tumor to freeze it, killing the cancer cells. Other methods use alcohol to kill the cells or other ways to heat the tumor (such as laser-induced thermotherapy). After the cancer tissue is destroyed, the space left behind may be filled with bone cement.

Bone-building medications

Medications commonly used to treat people with thinning bones may also help people with bone metastasis. These medications can strengthen bones and reduce the pain caused by bone metastasis, reducing the need for strong pain medications. Bone-building medications may also reduce your risk of developing new bone metastasis.

These drugs can be administered every few weeks through a vein in your arm or through an injection.

Click on Bone cancer to know the various sign and symptoms of early and advanced stages of cancer.

Click on palliative care  to know in detail about various problems faced by the patients with advanced cancer, bone metastasis and their solutions and how to live with advanced cancer?

Click on palliative care  to know in detail about palliative care.

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In advanced stage of cancer, if cancer spreads to multiple places and patient has many pain spots; or if the above mentioned treatment fails to control the pain in few patients; Pain implant is used to treat the pain.