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Pain (PDQ®)

Patient Version
Last Modified: 12/30/2011

Radiation Therapy to Relieve Pain

External Beam Radiation Therapy
Stereotactic Body Radiation Therapy
Bisphosphonates with Radiation Therapy
Radiopharmaceuticals
Radiofrequency Ablation

Radiation therapy may be used for pain relief rather than as treatment for primary cancer in patients with cancer that has spread to the bone. Radiation may be given as local therapy directly to the tumor or to larger areas of the body. Local or whole-body radiation therapy may make pain medication and other noninvasive therapies work better by directly affecting the cause of the pain (for example, by shrinking tumor size). Radiation therapy may help patients with bone pain from cancer to move more freely with less pain.

Pain flare is an increase in pain after radiation therapy that develops before pain is relieved. Pain flare is being studied in patients receiving radiation therapy for cancer that has spread to the bone.

External Beam Radiation Therapy

External-beam radiation therapy (EBRT) is a type of radiation therapy that uses a machine to aim high-energy x-rays at the cancer from outside the body. EBRT relieves pain from cancer that has spread to the bone in many patients. Radiation therapy may be given in a single dose or divided into several smaller doses given over a period of time. Single dose schedules and multiple dose schedules of EBRT are both effective for pain relief but single dose therapy is more likely to need to be repeated. Single dose EBRT for pain relief has not been found to cause more long-term harm than multiple dose EBRT. The decision whether to have single or multiple dose EBRT may also depend on how convenient the treatments are and how much they cost.

Stereotactic Body Radiation Therapy

Stereotactic body radiation therapy (SBRT) is a type of external radiation therapy that uses special equipment to position a patient and precisely deliver radiation to tumors in the body (except the brain). This type of radiation therapy helps spare normal tissue. SBRT may be used to treat cancer that has spread to the bone, especially spinal tumors. SBRT may also be used to treat areas that have already received radiation.

Bisphosphonates with Radiation Therapy

The use of radiation therapy given together with bisphosphonates is being studied in patients with cancer that has spread to the bone. More studies are needed to find out if giving bisphosphonates with radiation therapy relieves pain better than radiation therapy alone.

Radiopharmaceuticals

Radiopharmaceuticals are drugs that contain a radioactive substance that may be used to diagnose or treat disease, including cancer. Radiopharmaceuticals may also be used to relieve pain from cancer that has spread to the bone. A single dose of a radioactive agent injected into a vein may relieve pain when cancer has spread to several areas of bone and/or when there are too many areas to treat with EBRT. Small areas of cancer may respond to radiopharmaceuticals while large areas usually do not. A second treatment may be helpful in patients whose pain does not respond to a single treatment. One study showed that more than 2 doses of a radioactive substance called samarium 153 may be safe and effective in patients who responded to their first dose. Radiopharmaceuticals have not been shown to prevent the need for EBRT in relieving pain from cancer that has spread to the bone.

Radiofrequency Ablation

Radiofrequency ablation uses a needle electrode to heat tumors and destroy them. An imaging method is used to insert the electrode through the skin and guide the needle to the right location. This procedure may relieve pain in patients who have cancer that has spread to the bone. More study is needed to learn about possible risks and benefits.



Glossary Terms

bisphosphonate (bis-FOS-foh-nayt)
A drug or substance used to treat hypercalcemia (abnormally high blood calcium) and bone pain caused by some types of cancer. Forms of bisphosphonates are also used to treat osteoporosis and for bone imaging. Bisphosphonates inhibit a type of bone cell that breaks down bone. Also called diphosphonate.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
diagnosis (DY-ug-NOH-sis)
The process of identifying a disease, such as cancer, from its signs and symptoms.
dose (dose)
The amount of medicine taken, or radiation given, at one time.
drug (drug)
Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
electrode (ee-LEK-trode)
In medicine, a device such as a small metal plate or needle that carries electricity from an instrument to a patient for treatment or surgery. Electrodes can also carry electrical signals from muscles, brain, heart, skin, or other body parts to recording devices to help diagnose certain conditions.
external radiation therapy (...RAY-dee-AY-shun THAYR-uh-pee)
A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.
external-beam radiation therapy (...RAY-dee-AY-shun THAYR-uh-pee)
A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external radiation therapy.
imaging (IH-muh-jing)
In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as x-rays (high-energy radiation), ultrasound (high-energy sound waves), and radio waves.
local therapy (LOH-kul THAYR-uh-pee)
Treatment that affects cells in the tumor and the area close to it.
medication (MEH-dih-KAY-shun)
A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.
noninvasive (NON-in-VAY-siv)
In medicine, it describes a procedure that does not require inserting an instrument through the skin or into a body opening. In cancer, it describes disease that has not spread outside the tissue in which it began.
primary tumor (PRY-mayr-ee TOO-mer)
The original tumor.
radiation (RAY-dee-AY-shun)
Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).
radiation therapy (RAY-dee-AY-shun THAYR-uh-pee)
The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.
radioactive (RAY-dee-oh-AK-tiv)
Giving off radiation.
radiofrequency ablation (RAY-dee-oh-FREE-kwen-see a-BLAY-shun)
A procedure that uses radio waves to heat and destroy abnormal cells. The radio waves travel through electrodes (small devices that carry electricity). Radiofrequency ablation may be used to treat cancer and other conditions.
radiopharmaceutical (RAY-dee-oh-FAR-muh-SOO-tih-kul)
A drug that contains a radioactive substance and is used to diagnose or treat disease, including cancer. Also called radioactive drug.
response (reh-SPONTS)
In medicine, an improvement related to treatment.
samarium 153 (suh-MAYR-ee-um ...)
A radioactive substance used in the treatment of bone cancer and bone metastases (cancers that have spread from the original tumor to the bone). Samarium 153 is a radioactive form of the element samarium. It collects in bone, where it releases radiation that may kill cancer cells. It is a type of radioisotope.
schedule (SKEH-jool)
In a clinical setting, the step-by-step plan for how patients are to be treated; for example, the drug or type of radiation therapy that is to be given, the method by which it is to be given, the amount of time between courses, and the total length of treatment.
spinal column (SPY-nul KAH-lum)
The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The spinal column encloses the spinal cord and the fluid surrounding the spinal cord. Also called backbone, spine, and vertebral column.
stereotactic body radiation therapy (STAYR-ee-oh-TAK-tik BAH-dee RAY-dee-AY-shun THAYR-uh-pee)
A type of external radiation therapy that uses special equipment to position a patient and precisely deliver radiation to tumors in the body (except the brain). The total dose of radiation is divided into smaller doses given over several days. This type of radiation therapy helps spare normal tissue.
therapy (THAYR-uh-pee)
Treatment.
tissue (TIH-shoo)
A group or layer of cells that work together to perform a specific function.
total-body irradiation (TOH-tul-BAH-dee ih-RAY-dee-AY-shun)
Radiation therapy to the entire body. It is usually followed by bone marrow or peripheral stem cell transplantation.
tumor (TOO-mer)
An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
vein (vayn)
A blood vessel that carries blood to the heart from tissues and organs in the body.
x-ray (EX-ray)
A type of radiation used in the diagnosis and treatment of cancer and other diseases. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.