Patients diagnosed with cancer, especially advanced-stage or metastatic disease, often experience bone pain at some point in their cancer journey. Cancer-related bone pain may have many causes, but it’s not likely caused by primary bone cancer, which is very rare. Many cancers found in the bone are diagnosed as metastatic disease, which occurs when cancer cells break away from a primary tumor and spread to other parts of the body. Bones are a common location to which cancer metastasizes. Some cancers that commonly spread to the bones include breast cancer, lung cancer, prostate cancer, thyroid cancer and kidney cancer.
Cancer cells that spread to the bone disrupt the balance of normal cellular activity of the bone’s structure, damaging bone tissue, which may cause pain.
Other causes of cancer-related bone pain include:
- Pressure from a tumor pressing on the bone or nerves
- Cancer treatments that may damage or weaken bones
- Infection or inflammation
- Fractures
Unrelieved bone pain may affect your eating, sleeping, activity, mood and concentration. It may also slow your recovery from cancer treatment. Proper pain management may help you feel better so you can continue to participate in activities you enjoy.
Tips and treatments
Some treatments may help to reduce pain by shrinking the tumor. Others aim to reduce the risk of bone fractures and complications from bone metastases. Because of the complex nature of cancer-related pain, pain management usually involves a combination of techniques, such as:
- Orthopedic surgery to help stabilize weakened bones and prevent or repair fractures
- Radiation therapy that targets bone metastasis and destroys cancer cells that have settled in the bones
- Medications, such as anti-inflammatory agents, antibiotics, antidepressants and steroids, with an eye toward maintaining a balance between pain control and quality of life
Here are 10 steps you can take to help manage cancer-related bone pain:
Talk to your doctor. Untreated bone pain may interfere with your ability to battle the disease and reduce your quality of life. Talk to your doctor about pain-relief options and concerns you might have about taking pain medication.
Find a pain doctor. While your oncologists are focused on treating the disease, it may help to have a clinician focused solely on addressing your pain. A doctor who focuses on pain management may help develop a plan tailored to your needs, goals and preferences. If you’re seeing providers in different locations, make sure all members of your health care team are aware of the medications you’re taking.
Track your pain. Pain may sometimes be difficult to describe. Keep a record that includes the location of your pain, what makes it feel better or worse, how well your pain treatment is working, and any other pain relief methods you use. This information may help you better communicate your experience to your doctor.
Keep your doctor informed. Only you know where your pain is located, how it feels, how much it hurts, and what makes it better. Let your doctor know right away if you have any new pain, if your pain is getting worse, or if your pain medication is not working. Understanding the details of your pain may help your doctor determine what method of pain control works for you.
Stay on top of your pain. Pain is often better managed and relieved when treated early, rather than waiting until it becomes severe. Take your medication as instructed by your doctor, which usually means taking it on a regular schedule (even when you’re not feeling pain), and not skipping doses. Pain may get worse if you wait, and it may take longer or require larger doses of medication to get relief.
Pay attention to side effects. Pain medication, like other medications, has its own set of side effects, such as constipation, nausea, dizziness and drowsiness. Discuss potential side effects with your doctor so you know what to expect, and how to manage them if they develop.
Try supportive care therapies. Your care team may suggest other pain control methods, such as relaxation techniques, meditation, deep breathing, massage, physical therapy, hot/cold applications, acupressure or acupuncture. Emotional counseling and spiritual support may help promote your overall well-being.
Eat healthy and stay hydrated. A healthy, well-balanced diet is important for bone health. Sufficient calcium and vitamin D may help protect your bones. Protein is important for healing fractures and maintaining proper immune function. A registered dietitian may help you develop a meal plan tailored to you and your needs.
Try strength-building exercises. To strengthen bones and reduce bone loss, consider exercising regularly. Under the supervision of your care team, you may try walking, dancing and stair climbing, which build bone mass. Swimming and yoga may help stretch muscles and reduce pain. An oncology rehabilitation therapist may help determine the type and level of physical activity that is safe and appropriate for you.
Consider using an assistive device. Aids, such as canes, walkers, braces, splints, orthopedic shoes, grab bars and handrails, may help reduce the risk of falls, enhance balance and lessen bone pain. These devices may also promote your independence by making it easier for you to perform everyday activities. Your care team may recommend appropriate assistive devices for your needs.
Dr. Maurie Markman answers your questions about cancer and COVID-19 in his weekly Twitter chat.
