Interventional treatments for cancer pain due to bone metastasis

ABSTRACT

More than 30% of patients with cancer do not receive adequate pain-control treatment. Metastatic bone lesion-induced pain is one of the most common causes of cancer pain. Although cancer pain is reasonably well controlled using the World Health Organization analgesic ladder in most cases, metastatic bone lesion-induced pain generally does not respond well to traditional treatments. Interventional treatments are considered only when traditional treatments are ineffective or increasing the opioids dosage is impossible because of severe complications. In these cases, interventional treatments, such as peripheral nerve block, neuraxial block, vertebral augmentation, percutaneous cementoplasty, radiofrequency ablation, and cryoablation, can be considered. Fortunately, nerve block techniques show significant effects in many cases. The recent development of the intrathecal pump makes drug delivery safer and continuous for patients, without the need for replacement, until the end. Vertebral augmentation is a very useful pain-relieving method for metastatic spinal lesion pain. Vertebral augmentation and percutaneous cementoplasty provide stability and reinforcement to the weight-bearing bones and spine, thereby improving the quality of life of patients. Percutaneous radiofrequency ablation and cryoablation are applicable to painful metastatic spinal and bone lesions; when performed together with vertebral augmentation or percutaneous cementoplasty, the results are even better. If interventional treatments are appropriately performed at the proper time, they can have a synergistic effect and lower the rate of side effects compared to traditional treatments; thus, increasing the quality of life of patients with cancer and restoring their dignity until the end.