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To the Editor.—
In the article "Bone Metastases and Bone Pain in Breast Cancer" by Front and associates (242:1747, 1979), the authors point out that pain at the site of metastases in bone is present in only a minority of instances. This emphasizes that the pain is not due to the metastases nor the expansion of the metastases, but rather to the instability of the bone, resulting in traction on pain endings in periosteum or endosteum. This fact is either unknown or disregarded in the treatment of most patients with cancer. The common lore is that cancer causes pain. However, if the metastasis is to the bone, there is no pain until the bone becomes unstable in relation to the stress placed on it. Consequently, bracing or other adequate support relieves the pain, and narcosis is unnecessary. In soft tissues, cancer causes pain only when it produces distension of organ
Frederic J. Kottke. Bone Pain From Metastases. JAMA. 1980;243(23):2397. doi:10.1001/jama.1980.03300490015011