Management of pain in skeletal metastases.

Bone metastases can cause pain in several ways, including bone destruction, compression of nerve roots and spinal cord, and reactive muscle spasm. Pain management is correspondingly diverse, including primary and secondary analgesics, physical and psychologic nondrug methods, and modification of daily activities. Careful evaluation of the neuropathologic mechanisms underlying the patient's pain is the first step, followed by an explanation to the patient. Palliative radiation therapy is generally the preferred treatment, in addition to drug therapy with a combination of a nonsteroidal antiinflammatory drug and an opioid used in accordance with the World Health Organization Method for Relief of Cancer Pain. Alternative strategies are needed for neuropathic and functional muscle pains that are opioid resistant. Pain management is only 1 part of palliative care that also addresses psychologic, social, and spiritual aspects of suffering.