How should I approach the management of pain in a patient diagnosed with osteosarcoma undergoing treatment?

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 ¹.

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 ¹. For pain with neuropathic features or that is unresponsive to opioids, management should follow neuropathic pain guidelines ¹.

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 ¹. Radiotherapy can be employed for local pain control, particularly in cases of bone metastases or spinal involvement ¹.

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., 2013; Du et al., 2023) ¹.

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 ¹. Regular clinical reviews are essential to assess treatment effectiveness and adjust the pain management plan accordingly ¹.