Cancer and Bone Pain

A cancer patient you’re ministering to may experience bone pain at some point in his/her cancer journey, particularly if that person is battling advanced cancer.

Bone pain can cause a dull or deep ache in a bone or bone region (e.g., back, pelvis, legs, ribs, arms). This pain may worsen at night or during activity and can persist as the tumor grows.

Unrelieved bone pain can affect eating, sleeping, activity, mood, and concentration. It can also slow recovery from cancer treatment. On the other hand, proper pain management can help the patient feel better so s/he can continue to participate in enjoyable activities.

What Causes Bone Pain?

A common cause of bone pain is metastatic disease. Bone metastasis develops when cancer cells break away from a primary tumor and spread, usually through the bloodstream, to the bone.

Cancer cells that spread to the bone disrupt the balance of normal cellular activity, by which the bone is constantly being maintained, broken down, and rebuilt. This results in damage to the bone tissue, which can cause pain. Some additional causes of cancer-related bone pain include:

• The cancer itself (the tumor pressing on the bone or nerves)
• Cancer treatments (e.g., chemotherapy, hormone therapy)
• Infection or inflammation
• Complications of bone metastases (e.g., spinal cord compression)
• Weakened or fractured bones

Diagnosing Bone Metastasis

Cancer often metastasizes to the bone. Some cancers that commonly spread to bones include breast, lung, prostate, thyroid and kidney. Cancer rarely forms in the cells of the bone (called primary bone cancer).

To determine if bone pain is due to metastases, you might suggest to the cancer patient you’re serving that s/he ask the doctor if it would be possible to order a bone scan. In a bone scan, a small dose of radioactive material is injected into a vein and travels through the bloodstream, where it then gathers in the bones and is detected by a scanner through nuclear imaging. Other tests, such as X-rays, MRIs, and CT/PET scans, can be used to monitor the effects of the metastases over time.

Treatment for Cancer-Related Bone Pain

Treatment for cancer-related bone pain depends on many factors. Some treatments help to reduce pain by shrinking the tumor. Others aim to reduce the risk of bone fractures and complications from bone metastases.

Because of the complex nature of cancer-related pain, successful pain management usually involves a combination of techniques, such as the following:

• Surgery: Orthopedic surgery can help stabilize weakened bones and prevent or repair fractures. The patient’s doctor may place metal rods in bones to prevent them from breaking. In addition, kyphoplasty and vertebroplasty (which use image guidance to inject a cement-like material directly into a fractured bone through a hollow needle) can help rebuild collapsed vertebrae, restore height, and relieve pain.
• Radiation therapy: External beam radiation therapy uses X-rays to target bone metastasis and destroy cancer cells that have settled in the bones. Radiopharmaceutical therapy involves the injection of radioactive drugs (e.g., Quadramet®) through a vein to destroy cancer cells in a specific area of bone.
• Pain medications: Depending on the cause of the pain, the patient’s doctor may recommend various medications, such as anti-inflammatory agents, opioids, antibiotics, antidepressants, and steroids. Pain specialists strive to seek a balance between pain control and quality of life. If the patient you’re working with doesn’t have a pain physician, you might suggest s/he ask about one.
• Bisphosphonate drugs: These drugs (e.g., Zometa®) are typically given intravenously and can help prevent or delay bone destruction, normalize blood calcium levels, and reduce pain. Other bisphosphonate drugs may be given in pill form (e.g., Fosamax®) to prevent or slow bone loss during hormone therapy.

Note: This information is not intended nor implied to be a substitute for professional medical advice. Any patient you work with should always report any symptoms of cancer-related bone pain to the physician immediately.

Tips for Managing Cancer-Related Bone Pain

When you work with a cancer patient experiencing bone pain, here are some suggestions you can make to help them manage that pain:

• Clear up misconceptions. Discussing pain is not a sign of weakness. You have a right to pain relief and should insist on it. If you have fears about taking pain medication, talk with your doctor about the differences between addiction, physical dependence, and tolerance. Remember, untreated bone pain can interfere with your ability to battle the disease.
• Find a pain specialist. While your oncologists are focused on treating the disease, it helps to have a clinician focused purely on addressing your pain. A pain specialist can help develop a pain management plan that meets your needs. If you’re seeing providers in different locations, be sure all members of your healthcare team are aware of the medications you’re taking.
• Track your pain. You may find it difficult to communicate your pain experience to your doctor. To help describe your pain, keep a record that includes the location of your pain, what makes it feel better or worse, the effectiveness of your pain treatment and any other pain relief methods you use. This information will help you better communicate your pain experience to your doctor.
• Keep your doctor informed. Only you know where your pain is located, how it feels, how much it hurts, and what makes it better. Let your doctor know right away if you have any new pain, if your pain is getting worse, or if your pain medication is not working. Understanding the details of your pain will help your doctor determine what method of pain control works best for you.
• Stay on top of your pain. Pain is best managed and relieved when treated early, rather than waiting until it becomes severe. Take your pain medication as instructed by your doctor, which usually means taking it on a regular schedule even when you’re not feeling pain and not skipping doses. Pain may get worse if you wait, and it may take longer or require larger doses of medication to get relief.
• Pay attention to side effects. Pain medication, like all other medications, has its own set of side effects, such as constipation, nausea, dizziness, and drowsiness. Discuss potential side effects with your doctor so you know what to expect, and how you will manage side effects if they occur.
• Try complementary therapies. Your health care team may suggest other pain control methods, such as: relaxation techniques, meditation, guided imagery, distraction, deep breathing, massage, physical therapy, hot/cold applications, acupressure, auriculotherapy and acupuncture. In addition, emotional counseling and spiritual support may help reduce pain and promote overall well being.
• Eat a healthy diet and stay hydrated. A healthy, well-balanced diet is important for bone health. Sufficient calcium and vitamin D can help protect your bones. Protein is important for healing fractures and proper immune system functioning. Increasing your daily intake of fiber and drinking plenty of fluids can help prevent constipation. You may also want to limit sodium, which interferes with calcium retention. A registered dietitian can help develop a meal plan that works for you. 
• Try strength-building exercises. To strengthen bones and minimize bone loss, try exercising regularly. Under the supervision of your health care team, you may try walking, dancing, and stair climbing, which build bone mass. Swimming and yoga may help to stretch muscles and reduce pain. A rehabilitation therapist can help determine the type and level of physical activity that is safe and appropriate for you.
• Use assistive devices, if needed. Assistive devices (e.g., canes, walkers, braces, splints, orthopedic shoes, grab bars, handrails, etc.), may help reduce the risk of falls, enhance balance and lessen bone pain. These devices can also promote your independence by making it easier for you to perform everyday activities. Your health care team can recommend appropriate assistive devices for your needs.

Note: This information isn’t intended nor implied to be a substitute for professional medical advice. Please suggest to any patient you work with that s/he always seek the advice of a physician or other qualified healthcare provider regarding cancer-related bone pain.