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Table of Contents
7, No. 2, 2012
Issue release date: April 2012
Section title: Review Article · Übersichtsarbeit
Free Access
Breast Care 2012;7:113–120

Cancer Pain Management and Bone Metastases: An Update for the Clinician

Schneider G.a,b,c · Voltz R.a,b,c · Gaertner J.a,b,c
aDepartment of Palliative Care, University Hospital Cologne, bCenter for Integrated Oncology Cologne/Bonn, cCologne Clinical Trials Center, BMBF 01KN1106, Germany
email Corresponding Author

Dr. Jan Gaertner, Department of Palliative Care, University Hospital Cologne, 50924 Cologne, Germany, Tel. +49 221 478-3361, Fax -89300, jan.gaertner@uk-koeln.de

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Breast cancer patients with bone metastases often suffer from cancer pain. In general, cancer pain treatment is far from being optimal for many patients. To date, morphine remains the gold standard as first-line therapy, but other pure µ agonists such as hydromorphone, fentanyl, or oxycodone can be considered. Transdermal opioids are an important option if the oral route is impossible. Due to its complex pharmacology, methadone should be restricted to patients with difficult pain syndromes. The availability of a fixed combination of oxycodone and naloxone is a promising development for the reduction of opioid induced constipation. Especially bone metastases often result in breakthrough pain episodes. Thus, the provision of an on-demand opioid (e.g., immediate-release morphine or rapid-onset fentanyl) in addition to the baseline (regular) opioid therapy (e.g., sustained-release morphine tablets) is mandatory. Recently, rapid onset fentanyls (buccal or nasal) have been strongly recommended for breakthrough cancer pain due to their fast onset and their shorter duration of action. If available, metamizole is an alternative non-steroid-anti-inflammatory-drug. The indication for bisphosphonates should always be checked early in the disease. In advanced cancer stages, glucocorticoids are an important treatment option. If bone metastases lead to neuropathic pain, coanalgetics (e.g., pregabalin) should be initiated. In localized bone pain, radiotherapy is the gold standard for pain reduction in addition to pharmacologic pain management. In diffuse bone pain radionuclids (such as samarium) can be beneficial. Invasive measures (e.g., neuroaxial blockage) are rarely necessary but are an important option if patients with cancer pain syndromes are refractory to pharmacologic management and radiotherapy as described above. Clinical guidelines agree that cancer pain management in incurable cancer is best provided as part of a multiprofessional palliative care approach and all other domains of suffering (psychosocial, spiritual, and existential) need to be carefully addressed (‘total pain’).

© 2012 S. Karger AG, Basel

Article / Publication Details

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Abstract of Review Article · Übersichtsarbeit

Published online: April 27, 2012
Issue release date: April 2012

ISSN: 1661-3791 (Print)
eISSN: 1661-3805 (Online)

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