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Mechanisms and management of bone cancer pain
Research highlights
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Bone cancer pain is the most common presenting symptom in patients with skeletal metastases.
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Bone cancer pain has both nociceptive and neuropathic components.
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Persistent afferent stimulus from tumor-bearing bone induces peripheral and central sensitization.
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Bone cancer pain is recalcitrant to many standard strategies used for acute and chronic pain.
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Animal models and clinical trials have led to treatments targeting specific molecular mechanisms.
Introduction
Bone cancer pain is the most common presenting symptom in patients with skeletal metastases, is one of the most difficult pain entities to treat, and is directly proportional to its impact on patient quality of life [ , ]. There are two main types of cancer pain: baseline and breakthrough. Baseline pain is typically described as a dull and aching pain that is constant in nature and progresses in accordance with the disease process. Breakthrough pain is most commonly associated with bone metastases and is characterized as sharp, intermittent, and recalcitrant in nature. Incident pain on movement is the best-known cause of breakthrough pain and can be found in as many as 80% of patients with advanced disease [ , ]. Insight into understanding the pathophysiology of bone cancer pain and the development of new therapeutic strategies for treating this detrimental condition have been largely attributed to novel animal models and recent clinical trials.
Mechanisms of bone cancer pain
Animal models of bone cancer pain
Animal models, including rodent and canine models of osteolytic and osteoblastic bone metastases, have helped elucidate the etiology of bone cancer pain. While each model differs in type of tumor, route of inoculation, host immunocompetency, and species, a collective wealth of information has been gleaned regarding the pathophysiological mechanisms that drive bone cancer pain [ ]. Ultimately, bone cancer pain is a multifactorial process that is initiated by complex interactions between normal host and invasive tumor cells within the cancerous bone that signal responses from the peripheral and central nervous systems.
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