Mechanisms and management of bone cancer pain

Bone cancer pain is the most common presenting symptom in patients with skeletal metastases and is a unique pain entity recalcitrant to many standard strategies used for acute and chronic pain management. There are nociceptive and neuropathic components of bone cancer pain, which can be persistent at baseline, spontaneous and intermittent, or incident on movement. Bone cancer pain often evolves with disease progression, where continuous afferent stimulation of sensory nerve fibers induces peripheral and central sensitization. Understanding key molecular mechanisms regulating bone cancer pain in the peripheral and central nervous systems is contributing to the development of selective therapies with specific molecular targets. These treatments have the potential to be more efficacious with less systemic adverse side effects. Novel animal models and recent clinical trials have significantly advanced our understanding of bone cancer pain and will be further required to translate new therapeutic strategies from bench to bedside.