Bone metastasis pain is not always controlled by painkillers and radiotherapy alone. One option used abroad is image-guided local treatment: a thin needle is placed into the tumour inside the bone to destroy it with heat (radiofrequency ablation, RFA) or cold (cryoablation), and weakened bone can be reinforced with bone cement. In US and European multicentre studies, pain fell meaningfully from a few days to one week after the procedure, and the benefit lasted for 6 to 12 months.
Based on clinical studies from the US and Europe, patient information from MD Anderson Cancer Center and the 2026 insurance coverage news from Japan, this guide explains who is suitable, how the procedure works, what recovery and side effects look like, and how it differs from radiotherapy.
Treatment status · Performed with devices approved in the US and Europe for pain palliation. In Japan, bone metastases were added to the indications of a domestic RFA device in April 2026, with public insurance coverage. The aim is pain relief and bone stabilisation rather than cure. This article is general information, not a recommendation.
What local treatment for bone metastases is
Lung, breast, kidney and prostate cancers often spread to the spine, pelvis and ribs. Tumours growing inside bone irritate nearby nerves and weaken the bone, causing pain at rest or on movement. Local treatment targets the tumour that causes the pain, using three methods alone or together.
| Method | Principle | Typical sites |
|---|---|---|
| Radiofrequency ablation (RFA) | Electric current from the needle tip heats and destroys the tumour | Spine, pelvis, sacrum; often combined with bone cement |
| Cryoablation | An ice ball at the needle tip freezes and thaws the tumour repeatedly | Ribs, iliac bone, larger tumours; ice-ball margin monitored on CT |
| Bone cement (cementoplasty) | Medical cement (PMMA) is injected into weakened bone and hardens | Weight-bearing spine and pelvis; lowers fracture risk and pain on movement |
All three are image-guided needle procedures (interventional radiology) without a large incision.
See our RFA guide for how heat ablation works and our interventional radiology (IVR) guide for image-guided procedures in general.
Who is suitable
Local treatment is considered when the painful spot is clear and the tumour causing it is visible on imaging. Study criteria and MD Anderson's patient information point to the following groups:
- Pain in one or two clear locations: the OPuS One study enrolled patients with a worst pain score of at least 4 out of 10 at the target site.
- Sites already treated with radiotherapy: an option when repeat radiation is difficult. In the MOTION cryoablation study, 42.4% of participants had previous radiation to the treated lesion.
- Pain not controlled by medication: pain persists despite higher opioid doses, or side effects limit further increases.
- Patients who cannot pause systemic therapy for long: the procedure is short and fits around chemotherapy.
- Bone-destroying (lytic) metastases: fracture-prone spine and pelvis are reinforced with cement.
When pain is widespread or the tumour lies right next to the spinal cord or major nerves, radiotherapy or medication usually comes first, although some centres use nerve-protection techniques. The doctor who reviews the scans decides which approach fits.
The procedure: from tests to discharge
- Tests: CT or MRI to check tumour size and distance to nerves, plus blood tests (platelets, clotting). Blood thinners may be paused as instructed.
- Anaesthesia: sedation or general anaesthesia depending on site and pain.
- Needle placement and treatment: under CT or fluoroscopy. In MOTION, an average of 3 cryoprobes was used and the mean procedure time was about 100 minutes.
- Cement injection when needed: through the same needle path; cement was used in 97% of OPuS One procedures.
- Discharge: MD Anderson says most patients go home the same or next day; median hospital stay in MOTION was 26.6 hours. No stitches are needed.
Keeping a record of pain scores and painkiller doses afterwards helps judge the effect. Compare with our lung cancer RFA guide and long-term kidney cancer cryoablation results.
Results: how much did pain improve?
| Study | Patients | Main results |
|---|---|---|
| MOTION cryoablation (7 US and 4 European centres, Radiology: Imaging Cancer 2021) | 66 patients with painful bone metastases; mean age 60.8; lung 28.8%, breast 13.6%, kidney 12.1%; mean maximum tumour size 5.7 cm | Pain palliation in 92% (59 of 64). Worst pain fell by 2.61 points on average at week 8. Meaningful improvement from week 1, sustained to week 24 |
| OPuS One RFA (15 international centres, CVIR 2023) | 206 patients (264 procedures) with lytic or mixed metastases of the spine, pelvis and sacrum, mostly with cement | Meaningful pain reduction in 59.8% at 3 days. At 12 months, 83% meaningful improvement in worst pain and 74% complete or partial response. Quality of life (EQ-5D) improved at every visit from 3 days to 12 months |
Both are single-arm prospective studies. A meaningful reduction is a drop of 2 or more points on a 10-point scale.
In plain terms, more than 9 in 10 cryoablation patients reported less pain, and more than half of RFA patients felt a clear change within three days. In OPuS One, 34–51% of patients were able to lower their opioid dose depending on the visit, and no new fractures were reported in treated vertebrae.
How it differs from radiotherapy
Radiotherapy is the standard treatment for painful bone metastases; local ablation complements it, and the two can be combined.
| Item | Radiotherapy | RFA / cryoablation |
|---|---|---|
| Sessions | One to several outpatient sessions | Usually one procedure |
| Onset of pain relief | Gradual, often over weeks | From 3 days to 1 week in studies |
| Re-treating the same site | May be limited by cumulative dose | Possible after previous radiation |
| Bone reinforcement | No direct support | Cement can stabilise the bone |
| Anaesthesia and stay | None; outpatient | Sedation or general; same day to one night |
General comparison; the right choice depends on tumour location and overall condition.
MD Anderson's interventional radiologists consider local treatment for patients whose pain persists despite strong painkillers, for previously irradiated sites, and when pausing chemotherapy for radiation is a concern. Embolisation of tumour blood vessels is sometimes added.
Side effects and recovery
| Study | Reported side effects | Management |
|---|---|---|
| MOTION (cryo, 65 patients) | Grade 3–4 serious events 4.6% (3): abdominal pain, haematoma, skin frostbite. No procedure-related deaths | Skin protection for superficial tumours; haematoma observed or treated |
| OPuS One (RFA, 206 patients) | Procedure or device-related events 2.9% (6). No nerve or vessel injury, no new fractures at treated sites | Treated by the care team as needed |
The site may ache or pain may temporarily rise for a day or two, managed with painkillers. Leg weakness or changes in sensation should be reported right away. Most people resume daily activities within days, and systemic therapy can continue after discussion with the oncologist.
Where it is available
| Region | Status | Basis |
|---|---|---|
| United States | RFA and cryoablation offered at major cancer centres for pain palliation, including MD Anderson | OPuS One, MOTION, MD Anderson |
| Europe | Four European centres took part in MOTION; 15 international centres in OPuS One | MOTION, OPuS One |
| Japan | From 1 April 2026, indications of the domestic RFA device arfa expanded to lung cancer, small kidney cancer, bone metastases and pelvic cancers, with insurance coverage | Japanese pharmaceutical trade press (April 2026) |
International patients are often not covered by local public insurance; confirm availability and cost with the hospital.
Questions for your doctor
- Which bone tumour is causing my pain, and can it be treated locally?
- Is RFA or cryoablation better for me, and do I also need cement?
- Can a site that has already had radiotherapy be treated?
- What nerve protection is used if the tumour is close to nerves?
- When can I restart chemotherapy afterwards?
Also see five questions to ask before an RFA consultation.
Frequently asked questions
Does ablation relieve bone metastasis pain quickly?
Studies reported meaningful relief from 3 days to 1 week. In OPuS One, 59.8% improved clearly at 3 days; in MOTION, 92% of 64 patients achieved palliation. Timing varies between people.
Can a site already treated with radiotherapy be ablated?
Often, yes. In MOTION, 42.4% of participants had received radiation to the same site, and pain relief was confirmed in an analysis that included them.
How long is the hospital stay?
Most patients go home the same or next day. The median stay in MOTION was 26.6 hours, and the needle site heals within days without stitches.
Does it cure the cancer?
The main goals are pain relief and bone stabilisation to improve quality of life. Systemic treatment continues with your oncology team.
This article summarises overseas official sources and papers as general information and is not medical advice. Discuss treatment choices with a doctor who has examined you.
Sources (checked October 20, 2026)
- Jennings JW, Prologo JD, Garnon J, et al. Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study. Radiology: Imaging Cancer. 2021;3(2):e200101.
- OPuS One: Radiofrequency ablation for painful lytic bone metastases — 12-month results. CardioVascular and Interventional Radiology. 2023. doi:10.1007/s00270-023-03417-x
- MD Anderson Cancer Center. How interventional radiology is used to manage cancer-related bone pain
- Yakuji Nippo (April 7, 2026). Terumo RFA system arfa: indications expanded to lung cancer, small renal cancer and more (Japanese)