Development of an estimated 60 per cent to 84 per cent of patients with cancer bone metastasis. These symptoms of pain experienced 70 percent is difficult to manage that 50% die without adequate pain relief with the low quality of life. It is therefore essential medicines available and effective management of this condition. One of the most common pain syndromes in patients with advanced cancer bone metastasis. This is difficult to manage and control in clinical practice. Currently, the scientific advances in cancer screening and treatment for long periods in patients. Unlike the case of bone pain in cancer, where current treatment strategies largely effective with this phenomenon. Treating pain in bones palliative most based on clinical studies in patients in pain or pilot models aren't designed well and this could explain why drugs used partially effective. Today, was a major obstacle in the development of new treatments and safe to control pain bone the absence of basic scientific knowledge in bone pain physiology.
Epidemiology
Pain in cancer patients usually calendar, may arise from the same treatment side effects or both. For these reasons should be this presentation approaches and management disciplines. AIDS pain occurs with the proliferation or tumor invasion from metastatic tumor local from a distance. With bone metastatic pain often reflect a tumor in the breast or prostate, thyroid, adrenal and kidney, and lung.
Bone pain Physiology
Bone pain associated with tissue destruction of osteoclast cells. Normally, bone is risorbshan aostioklastik in balance with the formation of bone aostioblastes mediation. Increased walslamiat activity and a plastic materials such as cytokines, growth factors, parathyroid hormone-like peptides webrostaglandins. Uttakoids also released other owners of potassium ions, bradikinin, waustuklast activate factors. These materials and textiles play an important role in sensitizing the neural tissue against chemical agents and heat reduction cell membrane performance thresholds, and exaggerated responses to stimuli over the threshold and trigger discharges tonic motives usually silent nosisibtors. This phenomenon is called marginal initial awareness and understand wehaibralgisia massacre among infected tissue and stimulate Terminal nosisibtors (fibres c Delta fibre) translating the pain. In bone tissue of sensory receptors are located mainly in biriostiom, while not sensitive bone marrow and bone shell. This phenomenon causes Terminal abnormal sensitivity awareness pressures surrounding skin (allodinia wehaibralgisia), pain in muscles and joints and tendons deep tissue in contact with bone. This is limited to ensure a greater capacity to respond to the alarm of termination.
Activate the receptors nosisibtivi gives the constant presence of harmful process, provided the inflammation pain tends to be chronic with growth of bone metastases. These stimuli lead to other prevalent phenomenon called central sensitization, which include abnormal vital signs sensual amplification of the central nervous system, especially in the spinal cord. This phenomenon occurs because incentives continuing entry through fiber c this spinal temporary increase in synaptic silent power stations. In this process had an important role of receivers glotamati n-methyl-d-asbartati (nimda). Amplification of signals generated in the neural bostsinabtik sends a message to the brain which are interpreted as pain. In short the Central influences sensory awareness gives input terminal nosisibtivi (fibres c pain) and not nosisibtivi (touch screen).
In practice these phenomena come together in the genesis of bone metastatic pain and peripheral sensitization occurs sharp metastatic lesions appear nosisibtors and translate the information transferred by customer or a Delta fibers c milinatid aunmilinatade of the spinal cord where embedding information in different systems. With the preparation process of inflammation begins a process of education of Central sensory impulses that begin to activate silent. There is a central vision. Before becoming chronic pain phenomenon becomes more complicated because everything in contact with the infection becomes strong generator of pain. Mark to touch or movement of muscles or joints as a result, reveals the phenomenon allodinia wehaibralgisia more.
With the development and growth of metastatic disease can show nerve compression phenomena or peripheral nerve roots or the spinal cord. Then the pain can refer to other dermatomis, which further complicated the picture first. This requirement becomes debilitating factor for patient and insufficient control can result in the phenomenon of pain total detailed below.
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