open access

Vol 11, No 1 (2017)
Review paper
Published online: 2017-09-20
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Bone pain in cancer patients — what is known about its pathomechanisms?

Renata Zajączkowska12, Wojciech Leppert34, Jerzy Wordliczek12
Medycyna Paliatywna w Praktyce 2017;11(1):17-23.
Affiliations
  1. Klinika Intensywnej Terapii Interdyscyplinarnej Collegium Medicum Uniwersytet Jagielloński w Krakowie, Poland
  2. Poradnia Leczenia Bólu, Szpital Uniwersytecki w Krakowie
  3. Katedra i Klinika Medycyny Paliatywnej Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu
  4. Zakład Badań nad Jakością Życia, Gdański Uniwersytet Medyczny w Gdańsku

open access

Vol 11, No 1 (2017)
Review paper
Published online: 2017-09-20

Abstract

Bone is after lung and liver the third most common site of metastatic disease in cancer patients. Many cancer types including breast, prostate, lung, and kidney have a strong predilection to metastasize to bones, which induce pain, pathologic skeletal fractures, spinal instability and compression of the spinal cord or others structures of nervous system, hypercalcemia, decreased mobility and increased mortality. Bone cancer pain is a kind of chronic pain with unique and complicated pathophysiology with both a nociceptive and neuropathic component. The nociceptive component of cancer bone pain is driven by the release of pronociceptive substances produced by tumor and their stromal cells, acidosis caused by bone-destroying osteoclasts, and mechanical destabilization and fracture of the bone. The neuropathic component of cancer bone pain is induced by tumor cell growth which injures and destroys structures of nervous system and distal ends of nerve fibers that normally innervate the bone, by release factors that sensitize and activate bone nociceptors, and release growth factors that drive pathological ectopic sprouting of both sensory and sympathetic nerve fibers and neuroma formation. These newly sprouted nerve fibers which can be observed in the periosteum, mineralized bone, and marrow have a unique morphology, organization, and a high density that is never observed in normal bone. All described mechanisms contribute to peripheral and central sensitization observed in cancer patient with bone metastases.

Abstract

Bone is after lung and liver the third most common site of metastatic disease in cancer patients. Many cancer types including breast, prostate, lung, and kidney have a strong predilection to metastasize to bones, which induce pain, pathologic skeletal fractures, spinal instability and compression of the spinal cord or others structures of nervous system, hypercalcemia, decreased mobility and increased mortality. Bone cancer pain is a kind of chronic pain with unique and complicated pathophysiology with both a nociceptive and neuropathic component. The nociceptive component of cancer bone pain is driven by the release of pronociceptive substances produced by tumor and their stromal cells, acidosis caused by bone-destroying osteoclasts, and mechanical destabilization and fracture of the bone. The neuropathic component of cancer bone pain is induced by tumor cell growth which injures and destroys structures of nervous system and distal ends of nerve fibers that normally innervate the bone, by release factors that sensitize and activate bone nociceptors, and release growth factors that drive pathological ectopic sprouting of both sensory and sympathetic nerve fibers and neuroma formation. These newly sprouted nerve fibers which can be observed in the periosteum, mineralized bone, and marrow have a unique morphology, organization, and a high density that is never observed in normal bone. All described mechanisms contribute to peripheral and central sensitization observed in cancer patient with bone metastases.

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Keywords

bone pain, treatment, pathophysiology, bone metastases

About this article
Title

Bone pain in cancer patients — what is known about its pathomechanisms?

Journal

Palliative Medicine in Practice

Issue

Vol 11, No 1 (2017)

Article type

Review paper

Pages

17-23

Published online

2017-09-20

Page views

542

Article views/downloads

15885

Bibliographic record

Medycyna Paliatywna w Praktyce 2017;11(1):17-23.

Keywords

bone pain
treatment
pathophysiology
bone metastases

Authors

Renata Zajączkowska
Wojciech Leppert
Jerzy Wordliczek

References (21)
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