EVALUTATION OF THE CONTROL OF PAIN IN PATIENTS WITH BONE METASTASIS UNDERGOING MEDICAL TREATMENT WITH BISPHOSPHONATES

Background: The objective of the study is to assess the effectiveness of pain control in patients with bone metastases treated with bisphosphonates. Patients and Methods: 70 clinical records of patients affected by bone metastasis, treated at Molinette Hospital between 2006 and 2008 were enrolled. The following clinical data were collected: treatment with bisphosphonates, pain treatment, chemotherapy, radiation treatment, surgical therapy with vertebroplasty, spinal cord compression, pathological fractures, osteonecrosis of the jaw, assessment of pain control with numeric scale. Results: Patients treated with bisphosphonates (67%) did not have a good control of pain in 70% and 58% of them was treated with analgesics compared to 73% in the control group. We observed 3 cases of pathological fractures, all in patients treated with bisphosphonates; 6 cases of spinal cord compression, of which 4 in patients treated with bisphosphonates. 4 further cases of peridural space invasion without spinal cord compression occurred. Osteonecrosis of the jaw was diagnosed in one patient treated with both pamidronate and zoledronic acid, and in a second patient treated with zoledronic acid alone; in this case the treatment was not discontinued. Despite the various treatments used only 30% of patients reported good pain control. Conclusions: In our experience pain control among patients with bone metastases is suboptimal. Despite several studies demonstrating the ability of bisphosphonates to improve pain control, in our series of patients the concomitant administration of complementary therapy was necessary. Pain control in this subset of patients is a priority and needs to be addressed with several treatments which may include bisphosphonates