In the treatment of bone pain, the second step on the WHO analgesic ladder is commonly unhelpful, with inadequate pain relief or the development of undesirable/intolerable side-effects (Eisenberg, 2005). There is currently no place for interventional treatment on the ladder and the earlier recommendations of a fourth step of interventional management are not applied widely enough. The main principles of pain management, including the use of a biopsychosocial approach, should be applied, rather than simply following the WHO ladder. Mechanism-based strategies incorporating the recent scientific discoveries of the molecular and cellular changes in chronic and cancer pain are important. For example, treating.
