Bisphosphonates as adjuvant therapy in multimodal pain management

Bisphosphonates are broadly used in cancer metastasizing to the bone with the goal of preventing or delaying skeletal complications, which may dramatically deteriorate the status of the patient and course of disease. Zoledronate is approved for the prevention of skeletal morbidities in multiple myeloma, skeletally metastasized prostate cancer and other solid tumours; clodronate, ibandronate and pamidronate are approved in this setting in myeloma and breast cancer. Furthermore, pamidronate, ibandronate and zoledronate are licensed in the treatment of hypercalcaemia of cancer. Not unexpected, pain relief, looked for as a secondary objective in most of the studies, was observed in many instances. This review briefly summarizes the aspects of pain reduction achieved by bisphosphonates in cancer. Furthermore, original data on the benefit in pain reduction of high-dose ibandronate following a so-called “loading dose concept” is presented.