A 65-year-old woman with metastatic breast cancer has severe localised pain from a single thoracic vertebral metastasis. There is no neurological deficit and no cord compression on MRI. Oral morphine has been titrated adequately. Which intervention provides the most durable additional analgesia for this lesion?
- A Palliative external beam radiotherapy to the affected vertebra ✓
- B Addition of a corticosteroid taper
- C Intravenous pamidronate alone
- D Repeated caudal epidural injections
Correct answer: A. Palliative external beam radiotherapy to the affected vertebra
Explanation
Localised bone metastasis pain persisting despite optimised opioids responds to palliative radiotherapy, which produces complete or partial relief in the majority of treated sites within weeks. Corticosteroids are reserved for impending or actual cord compression with neurological signs, which are absent here. Bisphosphonates reduce skeletal events and give modest pain benefit but are adjunctive rather than definitive for a single painful lesion. Epidural steroids target radicular pain and are inappropriate for vertebral body metastatic pain.
Reference: Oxford Textbook of Palliative Medicine, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.