Image-guided percutaneous thermal ablation is a safe and effective method to reduce pain in patients with painful bone tumors. Computed tomography-guided radiofrequency or laser ablation is the modality of choice for most osteoid osteomas. Radiofrequency or laser thermal ablation also offers an alternative method for palliation of localized, painful osteolytic metastatic lesions. Pain can be reduced and neural damage prevented, improving the quality of life for patients with cancer who often have multimorbid conditions and limited life expectancy. A multidisciplinary approach that includes orthopedic surgeons, neurosurgeons, medical and radiation oncologists, and interventional radiologists is essential to manage these patients.