Mechanisms of, and Adjuvants for, Bone Pain

Nicholas Figura; Joshua Smith; Hsiang-Hsuan Michael Yu

doi:10.1016/j.hoc.2018.01.006

Mechanisms of, and Adjuvants for, Bone Pain

Hematol Oncol Clin North Am. 2018 Jun;32(3):447-458. doi: 10.1016/j.hoc.2018.01.006. Epub 2018 Mar 22.

Authors

Nicholas Figura¹, Joshua Smith², Hsiang-Hsuan Michael Yu³

Affiliations

¹ Department of Radiation Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA. Electronic address: nicholas.figura@moffitt.org.
² Department of Supportive Care Medicine, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA.
³ Department of Radiation Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA.

PMID: 29729780
DOI: 10.1016/j.hoc.2018.01.006

Abstract

Metastatic bone pain is a complex, poorly understood process. Understanding the unique mechanisms causing cancer-induced bone pain may lead to potential therapeutic targets. This article discusses the effects of osteoclast overstimulation within the tumor microenvironment; the role of inflammatory factors at the tumor-nociceptor interface; the development of structural instability, causing mechanical nerve damage; and, ultimately, the neuroplastic changes in the setting of sustained pain. Several adjuvant therapies are available to attenuate metastatic bone pain. This article discusses the role of pharmacologic therapies, surgery, kyphoplasty, vertebroplasty, and radiofrequency ablation.

Keywords: Bisphosphonate; Bone; Kyphoplasty; Metastatic; NGF; Pain; RANKL inhibitor; Vertebroplasty.

Publication types

Review

MeSH terms

Bone Neoplasms* / drug therapy
Bone Neoplasms* / pathology
Bone Neoplasms* / physiopathology
Bone Neoplasms* / secondary
Chemotherapy, Adjuvant / methods
Chronic Pain* / drug therapy
Chronic Pain* / pathology
Chronic Pain* / physiopathology
Humans
Neoplasm Metastasis