Patients with bony metastases in the spine, pelvis, or femora may have pain that escalates on movement, walking, standing, or even sitting. Opioid analgesics along with non-steroidal anti-inflammatory drugs are the mainstay of treatment, with the aim of making the patient comfortable at rest. Increasing the opioid dose further is often unhelpful as a dose sufficient to make movement possible is too sedating when the resting patient's opioid requirement is decreased. Rescue or breakthrough doses of normal release opioid are usually used in anticipation of movement, along with non-drug measures such as radiotherapy, possible surgery, and appropriate aids and appliances.
Bisphosphonates are interesting drugs established in the prevention of skeletal events due to metastases in most solid tumours. In some patients, analgesia can be achieved acutely, and trial evidence is emerging for good analgesia in pain due to bone metastases.
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