#### Summary points Pain is one of the most common symptoms managed in a palliative setting, and over half of all metastatic cancers will be associated with pain originating from bone metastases. Breast, lung, and prostate cancers account for about 80% of all bone metastases.1 Management of bone pain is especially important in patients with prostate or breast cancer as these patients may survive for many years with metastatic disease. Primary care physicians are well suited to provide palliative care as their long term relationships with patients and their families can result in a more satisfactory experience for all involved. All too often the management of bone pain from cancer metastases stops at opioids and non-steroidal anti-inflammatory drugs. Although specialists administer treatments such as radiation therapy and radiopharmaceuticals, family physicians must be aware of their role if they are to make appropriate referrals. Bone formation is a finely balanced process involving the continuous remodelling of bone through the activity of osteoclasts and osteoblasts. This dynamic process may be disrupted by the migration of cancer cells into bone, creating bone metastases. Metastatic lesions are intrinsically weaker than normal bone and can lead to multiple sequelae …