Palliative radiotherapy of bone metastases and pain flare

Radiotherapy is an effective modality for the palliation of symptomatic bone metastases with pain relief experienced by up to 80% of patients. Immediately following irradiation treatment, some patients experience an increase in pain, which is identified as a pain "flare". Approximately forty-percent of patients experience pain flare and can be greatly impacted by this phenomenon. Pain flare may have a debilitating effect on general functioning and quality of life, and the majority of patients prefer prevention of pain flare. Recent research has shown dexamethasone, a corticosteroid, to be an effective prophylactic agent reducing the incidence of pain flare to approximately 20% within a ten-day period following radiation treatment. Despite advances in reducing the incidence of pain flare, the mechanism behind this phenomenon is still largely unknown but may be related to inflammatory cytokines. Research is ongoing on pain flare urinary markers and dexamethasone metabolism to better understand the mechanism and experience of pain flare despite prophylaxis. This paper explores the incidence of pain flare, its impact on patients and the role of dexamethasone prophylaxis. Future investigations are also discussed