Mostafa Khaleghipour - Anesthesiologist, pain fellowship

Bone lesions are common in advanced cancer, particularly lung, prostate, breast, and multiple myeloma. These lesions are very focal, painful, and disabling. Metastatic non-small cell lung cancer is the leading cause of cancer death among men and women in the worldwide. Among patients with metastatic breast and prostate cancer, 65–75% will have bone metastases. Bone metastases in breast cancer have a high predilection for causing skeletal-related events (SRE): pathologic fractures, spinal cord compression, severe bone pain, structural impairment requiring prophylactic stabilization, and hypercalcemia.These patients require multimodal therapy. This includes analgesics, bracing (for support), protected weight bearing if the metastasis involves the lower limbs and activity modification. Antiresorptive agents may be necessary given the risk of hypercalcemia. Poly modal analgesic care may include nonsteroidal anti-inflammatory agents, muscle relaxants, antiepileptic drugs, anxiolytics, and opioids. Unfortunately, focal tumor metastases are difficult to treat with systemic methods. Radiotherapy and surgery may lead to morbidity. Percutaneous ablative procedures are used to target painful soft tissue tumors. These techniques are being used, with increasing frequency, in primary and metastatic bone tumors. These procedures offer a lower risk of morbidity compared to radiotherapy and surgery. These methods utilize imaging and specialized access devices. Tumor destruction is afforded by chemical agents (ethyl alcohol or acetic acid) or thermal energy (laser, microwave, ultrasound, cryotherapy, radiofrequency). Radiofrequency ablation produces a discrete thermal lesion and has been efficacious in painful skeletal metastases. Focal treatment with kyphoplasty, radiofrequency ablation, and targeted radiopharmaceuticals promote the principles of tumor debulking and necrosis for pain control. They enhance safety by minimizing collateral tissue damage.

Bone metastases, skeletal pain, pain management, Radiofrequency ablation