Bone cancer and pain

This chapter describes epidemiology and mechanisms of bone cancer pain. Pain is the most common presenting symptom in patients with skeletal metastases and is directly proportional to its impact on the cancer patient’s quality of life. Two main types of cancer pain exist: ongoing pain and breakthrough pain. Osteoclasts play an essential role in cancer-induced bone loss and contribute to the etiology of bone cancer pain. Selective inhibition of osteoclasts using either bisphosphonates or the soluble decoy receptor for RANKL, osteoprotegerin (OPG), results in inhibition of cancer-induced osteolysis, cancer pain behaviors, and neurochemical markers of peripheral and central sensitization. Significant insight into understanding bone cancer pain and the development of new therapeutic strategies for bone cancer pain are due to the development of novel animal models and recent clinical trials. The chapter further explores these therapeutic strategies.