BONE METASTATIC CANCER PAIN

Bone metastatic cancer pain happens when cancer cells spread to the bone. Some patients experience it after cancer therapy, while others notice it in the early stages of their cancer diagnosis. There is no single explanation for why it affects certain individuals more than others. The following cancers are known to spread to bone and cause this type of pain:

• Breast cancer, which research suggests spreads to bone in more than 70% of advanced cases
• Liver cancer
• Colon cancer
• Lung cancer, affecting an estimated 30% to 40% of advanced cases
• Prostate cancer, which research suggests spreads to bone in more than 70% of advanced cases
• Thyroid cancer

Often the first sign, and research identifies it as the most common symptom linked to skeletal complications from bone metastases. It tends to worsen with bone fractures, falls or injury, and the weakened bone becomes more vulnerable to further trauma.

such as turning in bed or lying on the affected area, layered over a constant dull ache.

This can occur as the cancer affects the body’s overall metabolism and energy use, and it is a symptom that should prompt timely medical evaluation.

Bone weakened by metastasis may struggle to withstand the normal pressure of standing or walking, causing pain during these everyday activities.

This reflects the growth of cancer cells within or around the bone and may be felt as a firm, gradually growing lump under the skin.

This can occur when bone breakdown raises blood calcium levels (hypercalcemia), which may increase thirst and fluid loss.

You should see a doctor promptly if you notice:

• Bone pain that is persistent, worsening, or disturbs your sleep at night
• A sudden increase in pain following a minor movement, fall or injury
• An enlarging mass at the site of pain
• Unintentional weight loss alongside bone pain
• Pain that does not improve with rest or standard painkillers

Early evaluation allows your care team to investigate the cause and start appropriate management sooner.

Bone metastatic cancer pain may be picked up through indicators such as elevated calcium levels (hypercalcemia) or spinal compression, but reaching a diagnosis requires careful clinical evaluation. At Singapore Paincare, our team of primary care and specialist pain physicians works alongside your oncologist to conduct a thorough assessment. This includes a physical examination, a review of your symptoms, and an evaluation of your medical history. An X-ray or CT scan may be used to evaluate or confirm the extent of the condition.

Treatment cannot cure bone metastatic cancer, but it can relieve pain and improve quality of life. Studies suggest that better pain relief may have a positive impact on a patient’s overall wellbeing, immunity and energy levels. At Singapore Paincare, we aim to treat pain using the least invasive option appropriate for each patient, after accurately identifying the cause. Our approach focuses on addressing pain generators through specialised injections and minimally invasive procedures. Combined with pharmacological treatment and rehabilitative therapy, this approach may help patients improve daily function and reduce the likelihood of pain recurring.

This technique uses medications or chemicals to block pain signals and interrupt further transmission from the affected nerve. A one-time specialised injection introduces chemical agents to the painful nerve area, targeting sensory nerves rather than motor nerves, so it does not cause weakness or paralysis.

Chemotherapy uses drugs to destroy cancer cells. It may be given before surgery to prevent cancer cells from dividing and spreading, or after surgery to clear any remaining cancerous cells. Common drug combinations include cisplatin, oxaliplatin and fluorouracil, among others.

Medications are an integral part of cancer pain management. This may include targeted therapies to support the body and limit damage to surrounding tissue. Our specialists may recommend treatments such as bisphosphonates (a type of hormone therapy that can slow bone damage) or radiopharmaceuticals (radioactive element drugs that target cancer cells). Steroids may also be used to reduce bony swelling caused by metastatic infiltration.

This is a biological therapy that may be considered when chemotherapy is not effective. It works by boosting the body’s own defences against cancer. The drugs used differ from chemotherapy and may cause side effects such as diarrhoea or weight changes.

Radiation therapy uses high-energy X-rays directed at the affected area to destroy cancer cells. Research indicates that around 7 in 10 patients experience some pain relief with radiotherapy for bone metastases, though individual results vary. Possible side effects include skin reactions, stomach discomfort and loose bowel movements.

This technique uses heat to disrupt the transmission of pain signals from an affected nerve, offering a relatively simple way to relieve pain. It is delivered through a one-time injection and may be repeated every 3 to 6 months as needed.

. For pain that is difficult to control or does not respond well to opioids or standard painkillers, a targeted infusion of morphine and local anaesthetic into the spinal cord may help. Because the spinal cord contains many pain receptors, delivering micro-doses of medication directly there can provide meaningful pain relief while reducing opioid-related side effects, with morphine requirements potentially reduced by 80% to 90%. Once the infusion catheter is placed at the correct spinal level, medication can be delivered through an external or internally implanted pump, with dosing adjusted to each patient’s needs.

Our specialists offer supportive care that addresses the emotional, social and financial aspects of living with cancer. This may include dietary management advice, such as reducing alcohol consumption or using supplements to support digestion. Each care plan is tailored to the individual patient.

If non-surgical methods are not effective, surgery may be recommended. As with any surgery, this comes with associated risks, complications and recovery time, so it may not be suitable for everyone. It is worth discussing the pros and cons of both non-surgical and surgical options carefully with your care team before deciding.

When conservative treatments are not effective, doctors may recommend debulking surgery to reduce the tumour load, or palliative surgery to relieve pressure on surrounding structures.

If a bone has fractured, reconstructive surgery, such as the use of metal plates, screws, wires, nails or pins, may be used to stabilise the affected area.

Regular yearly health screening can help with early cancer detection. In the early stages of cancer, systemic treatments may be prescribed alongside surgery to help reduce the risk of the cancer spreading to the bone.

References

1. Prevalence and prognosis of bone metastases in common solid cancers at initial diagnosis: a population-based study. PMC.
2. Incidence of patients with bone metastases at diagnosis of solid tumors in adults: a large population-based study. PMC.
3. Pain Response Rates After Conventional Radiation Therapy for Bone Metastases: A Systematic Review and Meta-Analysis. PubMed.
4. An Update on the Management of Bone Metastases. PMC.

Updated July 2026