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Managing Breast Cancer Bone Pain

Metastatic breast cancer can spread beyond the breast and lymph nodes to various bones in the body. The ribs, spine, pelvis, and long bones in the arms and legs are most common. More than 50% of women who develop stage IV breast cancer will find cancer has spread to their bones. Sometimes called secondary breast cancer, cells from cancer in the breast spread through the blood or lymphatic system to other areas of the body.1-3

A multidisciplinary approach to managing bone pain is designed to improve the quality of life. Goals are to reduce pain, to maintain and improve mobility, and strengthen the bones, as well as slow the cancer growth.

Palliative care for bone metastases

Caring for people with bone metastases is about reducing pain and improving quality of life. Called palliative care, it is its own medical specialty, focused not on treating the underlying disease, but the symptoms.4 The objective of palliative care is to improve quality of life for patients and their families.

What happens when cancer spreads to the bones

When cancer spreads into the bones it causes pain, weakness, and can make bones brittle and more likely to break. Legs and hips can easily fracture because they carry the burden of supporting body weight.4,5 If you experience new pain or pain that continues or gets worse when resting or lying down, it is important to consult your doctors.2,3,4

Metastatic bone pain generally comes on gradually, getting progressively more severe. It typically begins in one localized area and is often experienced at night in weight-bearing positions like standing.3 Local and systemic treatments are both prescribed for treating bone pain.

Different kinds of pain medicines can be helpful in treating cancer bone pain. These include over-the-counter and prescription pain relievers like opioid medications. They come in different forms including pills, patches, sprays, and pumps that let you dose the medication as you need it. Like with other conditions, it can take time to identify the right type or combination of pain medicines that work best.4

Diagnosing and preventing fractures

Imaging tests are used to diagnose disease that has spread to the bone and possible fractures. Diagnostic tools include bone CT or PET scan, X-rays, and MRIs. There are bone-strengthening medications and surgical supports that can help to prevent bones from breaking.2,4,5

Causes of bone pain

Cancer cells damage bones leaching calcium from the bones into the blood. This can cause hypercalcemia, high blood calcium levels. At first, symptoms include constipation, frequent urination, sleepiness, and unquenched thirst due to dehydration. Later symptoms may include muscle weakness, achiness, confusion, coma, and kidney failure. IV fluids and bisphosphonate drugs are part of the treatment for hypercalcemia.4,5

Spinal cord compression can happen when cancer spreads to the spine. You might experience back pain, numbness in the abdomen or legs, weakness or incontinence.4

Treatment approaches and coping mechanisms for bone metastases and pain

Treatment is designed to relieve pain, maintain mobility or even improve it and strengthen the bones as well as to slow the growth of cancer. Decisions about treatment approach will consider the location and spread of cancer, the specific symptoms, treatments that have been tried in the past and the general health of the patient. They can be medical, surgical and psychological.2-5

  • Bone building medications are designed to strengthen bones and reduce the damage caused by cancer.
  • Pain medications are used to reduce pain.
  • Chemotherapy uses drugs to destroy or damage cancer cells.
  • Hormone therapy uses medicines to block or reduce the hormone levels in the body to slow or stop the cancer cell growth.
  • Steroids can reduce inflammation and help reduce an allergic reaction to certain drugs. They help destroy cancer cells and can make chemotherapy more effective.
  • Targeted therapy uses drugs that block the growth and spread of cancer by interfering with specific genes, proteins, or tissues that cause individual cancer growth.
  • Radiation therapy uses beams of intense energy to kill cancer cells.
  • Surgery is a way to remove a tumor, the source of the pain, or to stabilize weakened bones to prevent or repair fractures.
  • Massage therapy can help ease the effects of stress and general aches and pains.
  • Exercise provides benefits as remaining active can help with attitude, endurance, and strength.
  • Relaxation techniques include breathing and muscle relaxation exercises, guided imaging, and meditation.
  • Mindfulness can improve chronic pain, low back pain, as well as mood and stress levels.
  • Hypnosis is used in palliative care to help control nausea and induce relaxation.
  • Psychotherapy can help people who develop anxiety and depression or have a prior history of psychiatric illness.

Looking to the future for solutions to bone pain

Treatment options continue to be developed to solve for bone pain. Pain should not be considered a normal part of having cancer.4 Pain should be treated, and with good management can be controlled or relieved. Support groups offer another approach to managing pain. Talking with other cancer survivors can help offer insight into what you are feeling, offering ways in which others have resolved pain and discomfort.5

  1. Secondary metastatic breast cancer in the bone. Available at: https://www.breastcancercare.org.uk/information-support/secondary-metastatic-breast-cancer/secondary-breast-cancer-diagnosis/secondary-breast-cancer-in-bone. Accessed 5.3.19.
  2. Bone Metastasis: Symptoms and Diagnosis. Available at: https://www.breastcancer.org/symptoms/types/recur_metast/metastic/bone. Accessed 5.3.19.
  3. RBuga, S. Sarria, J. The Management of Pain in Metastatic Bone Disease. Available at: https://moffitt.org/File%20Library/Main%20Nav/Research%20and%20Clinical%20Trials/Cancer%20Control%20Journal/v19n2/154.pdf. Accessed 5.3.19.
  4. Managing Symptoms of Bone Metastases. Available at: https://www.cancer.org/treatment/understanding-your-diagnosis/advanced-cancer/managing-symptoms-of-bone-metastases.html. Accessed 5.3.19.
  5. Bone Metastasis. Available at: https://www.mayoclinic.org/diseases-conditions/bone-metastasis/symptoms-causes/syc-20370191. Accessed 5.3.19.

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