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  NUCLEAR MEDICINE APPLICATIONS FOR BONE METASTASES 

The Quarterly Journal of Nuclear Medicine 2001 March;45(1):65-77

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Pathogenesis and pharmacological treatment of bone pain in skeletal metastases

Ripamonti C., Fulfaro F.

From the Rehabilitation, Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy *SAMOT, Società per l’Assistenza al Malato Oncologico Terminale, Palermo, Italy


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Sixty-­five per­cent of ­patients ­with ­advanced can­cer ­present ­bone metas­ta­ses and ­most of ­them ­present a rath­er ­slow clin­i­cal ­course char­ac­ter­ized by ­pain, mobil­ity def­i­cienc­es and skel­e­tal com­pli­ca­tions ­such as frac­tures and spi­nal ­cord com­pres­sion. Metastatic involve­ment of the ­bone is one of the ­most fre­quent caus­es of ­pain in can­cer ­patients and rep­re­sents one of the ­first ­signs of wide­spread neo­plas­tic dis­ease. The ­pain may orig­i­nate direct­ly ­from the ­bone, ­from ­nerve ­root com­pres­sion or ­from mus­cle ­spasms in the ­area of the ­lesions. The mech­a­nism of met­a­stat­ic ­bone ­pain is main­ly somat­ic (noc­i­cep­tive) ­even ­though, in ­some cas­es, neu­ro­path­ic and vis­cer­al stim­u­la­tions may over­lap. The con­ven­tion­al symp­to­mat­ic treat­ment of met­a­stat­ic ­bone ­pain ­requires the use of mul­ti­dis­ci­pli­nary ther­a­pies ­such as radio­ther­a­py in asso­ci­a­tion ­with system­ic treat­ment (hor­mo­no­ther­a­py, chem­o­ther­a­py, radio­iso­topes) ­with the sup­port of anal­ge­sic ther­a­py. Recently, stud­ies ­have indi­cat­ed the use of bisphos­pho­nates in the treat­ment of ­pain and in the pre­ven­tion of skel­e­tal com­pli­ca­tions in ­patients ­with met­a­stat­ic ­bone dis­ease. In ­some ­patients phar­mac­o­log­i­cal treat­ment, radio­ther­a­py, radio­iso­topes admin­is­tered ­alone or in asso­ci­a­tion are not ­able to man­age ­pain ade­quate­ly. The ­role of neu­ro­in­va­sive tech­niques in treat­ing met­a­stat­ic ­bone ­pain is debat­ed. The clin­i­cal con­di­tions of the ­patient, his ­life expec­tan­cy and qual­ity of ­life ­must ­guide the phy­si­cian in the ­choice of the ­best pos­sible ther­a­py.

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