Pain following palliative radiotherapy in a patient with bone metastases

Pain is a common accompanying symptom in patients with bone metastases. Radiotherapy is a well-established palliative treatment for symptomatic bone metastases, with initial pain relief onset varying from several days to four weeks and lasting between three to six months. Pain flare, or temporary worsening of pain at bone metastases sites following radiotherapy, have been reported to vary widely in incidence but typically occur within the first five days post-treatment. We present the case of a 70-year-old man experiencing right-sided chest pain, previously diagnosed with metastatic colorectal carcinoma. Computed tomography revealed progression of the destructive right anterior sixth rib metastasis with surrounding soft tissue mass, and pain was reported in the associated areas. The patient was treated with radiotherapy and given a single dose of 8 Gy. He experienced rapid onset of pain flare approximately half a day following treatment, as might be considered typical. The patient also experienced rapid onset of complete pain relief the following morning at one day post-therapy, an uncharacteristically short duration relative to previously-reported cases. Our case supports that pain flare is indicative of a positive response to radiotherapy as has been previously proposed. Our findings also suggest the potential subjectivity of the timing and severity of pain onset across bone metastases patients, which warrants therapy and follow-up tailored on a case-by-case basis.