Abstract
As targeted therapies help patients with advanced cancer live longer, interventions for management of axial spine pain will become more common. Unfortunately, the indications for and safety of these procedures have been relatively unexplored compared with non-cancer adults. This review focuses on the following aspects of axial spine pain management in patients with vertebral metastatic disease: (1) pathophysiology and symptoms of cancer- and non-cancer-related spine pain; (2) safety and efficacy of non-interventional rehabilitation approaches to treat this pain; (3) considerations for interventional pain approaches to acute and chronic pain in patients with vertebral metastatic disease. This review also summarizes gaps in the literature and describes specific cases in which the described interventions have been applied.
Highlights
The prevalence of vertebral metastatic disease (VMD) continues to increase due to improved treatment options of primary tumors that give rise to vertebral metastases [1]
Back pain in the setting of VMD can be generated by the malignancy itself or from more typical pain generators— herniated disks, spondylosis, muscle strain, and more
Physical exam findings would be typical of non-malignant back pain, and imaging studies may show chronic or acute changes consistent with non-cancer pain generators
Summary
The prevalence of vertebral metastatic disease (VMD) continues to increase due to improved treatment options of primary tumors that give rise to vertebral metastases [1]. Two-thirds of adults with cancer that have metastasized to bone will develop VMD, not all patients will have pain nor neurologic deficits [2]. Non-malignant back pain is incredibly common −80% of all adults will develop non-cancer low back pain (LBP) in their lifetime—making identifying the pain generator in patients with VMD and LBP both challenging and critical, as the treatment for each is drastically different [3]. Management of pain in VMD requires a multidisciplinary framework, including interventional procedures and noninterventional rehabilitation approaches when cancer is not generating the pain [4]. It is not always clear what interventions can be safely and effectively administered to patients with VMD. This review summarizes rehabilitation approaches to diagnosing and managing LBP in patients with VMD
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