Management of pain in a patient with osteosarcoma undergoing treatment should begin with an individualised pain assessment that evaluates the severity, location, characteristics, and impact of pain on daily activities and emotional wellbeing. This assessment guides a tailored pain management plan that considers previous analgesic strategies, patient concerns, and expectations NICE NG234.
Pharmacological treatment should include non-opioid and opioid analgesics, used alone or in combination, with careful dosage titration and monitoring for side effects and drug interactions, especially considering the patient’s comorbidities and concurrent medications NICE NG234. For pain with neuropathic features or that is unresponsive to opioids, management should follow neuropathic pain guidelines NICE NG234.
Given osteosarcoma’s potential for bone involvement and metastasis, adjunctive therapies such as bisphosphonates or denosumab may be considered to reduce skeletal-related events and pain, although their use should be based on tumour type and evidence of bone metastases NICE NG234. Radiotherapy can be employed for local pain control, particularly in cases of bone metastases or spinal involvement NICE NG234.
Non-pharmacological approaches including physical therapy, immobilisation (e.g., bracing), and psychological therapies should be integrated to support coping strategies and maintain mobility, especially if spinal stability is a concern Katonis et al. 2013Du et al. 2023 NICE NG234.
Early involvement of specialist pain or palliative care services is recommended if pain is severe, difficult to control, or significantly limits quality of life, to optimise symptom management and provide psychological support NICE NG234. Regular clinical reviews are essential to assess treatment effectiveness and adjust the pain management plan accordingly NICE NG234.