骨転移の緩和ケア

Palliative care for bone metastases

骨転移による苦痛のある患者に対する緩和ケア戦略には，手術，放射線治療，薬物療法，リハビリテーションなどがある。本稿では，鎮痛を目的とした薬物療法について述べるとともに，緩和ケア領域で放射線治療がより普及するために必要なことを提案したい。

Palliative care strategies for patients with painful bone metastases include surgical therapy, radiotherapy, pharmacotherapy, and rehabilitation. Differentiation between continuous（rest）and breakthrough（movement-evoked）pain is the most important point of pharmacotherapy to reduce pain from bone metastases, as therapy plans markedly vary between the 2 types of pain. Rest pain is manageable with opioid analgesics in many cases. In contrast, in movement-evoked pain, priority is given to multidisciplinary treatment focused on skeletal stability, rather than drugs. Movement-evoked pain from bone metastasis is often refractory to treatment, and radiotherapy is indispensable for its management. With the improvement of cancer survival rates, the importance of radiotherapy and palliative care team approaches will further increase in the future.