Dados do Trabalho

Título

HOW TO TREAT PATIENTS WITH REFRACTORY PAIN FROM BONE METASTASES? A SYSTEMATIC REVIEW

Introdução

Bone is a common site of metastasis of certain malignancies, and are mostly related to prostate and breast cancer. In oncological patients, bone pain is highly suggestive of metastasis, and is related to a short-term prognosis. These implants usually cause a poorly localized pain, which tends to be worse at night. Pain, in this context, may be inflammatory or mechanical, or even a mixed type. Depending on the tumor histology and the nature of the bony lesions, some first-line treatments are chosen. However, they fail for some patients, which are considered refractory. For this subset of individuals, other treatment options are then necessary.

Objetivo

To describe which therapeutic alternatives have been employed to treat patients with chronic refractory pain from bone metastases.

Método

A systematic review of English and non-English articles was performed using PubMed and EMBASE (2011-2021). Search terms included “pain management”, “bone metastasis”, and “drugs”. From 210 articles, selection was based on title, abstract, and study design, and 32 articles were included. Only clinical studies for patients with refractory pain were included. Data extraction was performed on the pharmacological and nonpharmacological methods employed to treat these patients.

Resultado

From 32 included studies, 24 (75%) used pharmacotherapy alone, 7 (21.9%) used nonpharmacologic methods, and 1 (3.1%) utilized a combined approach. From the studies that used drugs, the most common class was the radiopharmaceuticals (n = 14, 56%), followed by bisphosphonates (n = 3, 12%) and opioids (n = 2, 8%). On the other hand, the nonpharmacologic strategies mostly included different modalities of radiotherapy (n = 4, 50%), such as radiotherapy, radiofrequency, and radioablation. All studies reported significant clinical improvement of pain intensity and tolerability.

Conclusão

Several studies have been developed to address ways to treat chronic refractory pain in patients with bone metastases from diverse primary sites. These patients are usually at advanced stages, and some are in palliative care. Pain control in some cases becomes the most clinically relevant therapeutic approach that can be offered to such patients. Besides the first-line pharmacological available options, we are noticing a surge in the application of radiopharmaceuticals and different modalities of radiotherapy as promising alternatives, thus providing adequate pain control and fostering quality of life.

Palavras-chave

Pain Management, Bone Metastasis, Palliative Care