Drugs reduce bone cancer damage but clinical guidance remains non-specific

May 15, 2012

Bone cancer-related fractures and pain can be reduced by drug treatment, but no one drug is superior, according to a review published in The Cochrane Library. Researchers undertook a systematic review of the current evidence on bisphosphonate drugs, which are used to prevent bone damage in multiple myeloma.

Multiple myeloma is a type of cancer that grows in and on bones, and can cause fractures in long bones and the spine. Severe back pain is a common symptom. Bisphosphonate drugs may help to reduce the occurrence of fractures and bone pain in myeloma patients. They work by inhibiting the activities of bone cells called osteoclasts, which are involved in the formation of fractures. Many different bisphosphonate drugs are available, but their relative merits are uncertain.

The researchers analysed data from 20 trials involving a total of 6,692 patients who took bisphosphonate drugs including zoledronate, clodronate, pamidronate, ibandronate and etidronate in addition to their myeloma treatments. Bisphosphonates reduced the occurrence of fractures and pain. For all types of fractures, the researchers estimated that between 6 and 15 patients would need to be treated to prevent fractures in one patient. For pain, between 5 and 13 patients would need to be treated to reduce pain in one patient.

Four trials made direct comparisons between different drugs. In the remaining trials, the effects of the drugs were compared to those of placebos or no treatment and the researchers made indirect comparisons by interrogating the data from these trials. Head-to-head trials suggested that zoledronate was more effective at reducing fractures compared to etidronate, but taken together with the indirect comparisons, the researchers conclude that no one drug can be regarded as superior.

"Whether zoledronate is superior to any other bisphosphonate drug remains an open question," said lead researcher Ambuj Kumar of the Center for Evidence Based Medicine and Health Outcomes Research at the University of South Florida, in Tampa, Florida. "In light of the inconsistencies we see in the data, it is difficult to recommend any drug as a preferential treatment for clinical practice."

Based on the findings of the review, adverse effects of bisphosphonate drugs appear to be rare. Osteonecrosis of the jaw (a disease whereby the jaw bone can appear through lesions in the gum which do not heal) is one potential complication that has been gaining attention in recent years, but the authors report that it is no more common in those taking bisphosphonate drugs than in those receiving placebos or no treatment. "We didn't identify any significant adverse effects, but this work does highlight the need for larger head-to-head trials, which are needed to better compare the safety and effectiveness of the different drugs available," said Kumar.
-end-


Wiley

Related Pain Articles from Brightsurf:

Pain researchers get a common language to describe pain
Pain researchers around the world have agreed to classify pain in the mouth, jaw and face according to the same system.

It's not just a pain in the head -- facial pain can be a symptom of headaches too
A new study finds that up to 10% of people with headaches also have facial pain.

New opioid speeds up recovery without increasing pain sensitivity or risk of chronic pain
A new type of non-addictive opioid developed by researchers at Tulane University and the Southeast Louisiana Veterans Health Care System accelerates recovery time from pain compared to morphine without increasing pain sensitivity, according to a new study published in the Journal of Neuroinflammation.

The insular cortex processes pain and drives learning from pain
Neuroscientists at EPFL have discovered an area of the brain, the insular cortex, that processes painful experiences and thereby drives learning from aversive events.

Pain, pain go away: new tools improve students' experience of school-based vaccines
Researchers at the University of Toronto and The Hospital for Sick Children (SickKids) have teamed up with educators, public health practitioners and grade seven students in Ontario to develop and implement a new approach to delivering school-based vaccines that improves student experience.

Pain sensitization increases risk of persistent knee pain
Becoming more sensitive to pain, or pain sensitization, is an important risk factor for developing persistent knee pain in osteoarthritis (OA), according to a new study by researchers from the Université de Montréal (UdeM) School of Rehabilitation and Hôpital Maisonneuve Rosemont Research Centre (CRHMR) in collaboration with researchers at Boston University School of Medicine (BUSM).

Becoming more sensitive to pain increases the risk of knee pain not going away
A new study by researchers in Montreal and Boston looks at the role that pain plays in osteoarthritis, a disease that affects over 300 million adults worldwide.

Pain disruption therapy treats source of chronic back pain
People with treatment-resistant back pain may get significant and lasting relief with dorsal root ganglion (DRG) stimulation therapy, an innovative treatment that short-circuits pain, suggests a study presented at the ANESTHESIOLOGY® 2018 annual meeting.

Sugar pills relieve pain for chronic pain patients
Someday doctors may prescribe sugar pills for certain chronic pain patients based on their brain anatomy and psychology.

Peripheral nerve block provides some with long-lasting pain relief for severe facial pain
A new study has shown that use of peripheral nerve blocks in the treatment of Trigeminal Neuralgia (TGN) may produce long-term pain relief.

Read More: Pain News and Pain Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.