Spinal metastases with pain are a common and significant problem for patients with advan-ced cancer. The long-term management of ref-ractory spinal pain requires a multidisciplinary approach. Management of bone pain includes analgesia, hormones, chemotherapy, surgery, biphosphonates, external beam radiation and radiopharmaceuticals. External beam radiation therapy is the treatment of choice in single site of painfull metastases, in impending pathologic fracture and spinal cord compression. Pain pal-liation therapy with radionuclides such as Phosphorus-32, Strontium-89 , Samarium-153 and Rhenium-186 should be actively considered especially in patients with widespread painful os-teoblastic spinal metastases. It is a cost-effecti-ve systemic therapy to relieve pain from skeletal metastases with a consequent decrease in mor-bidity with an improvement in quality of life. Side effects are usually mild and limited to tempo-raıy myelosupression, influenced by the admi-nistred activity and bone marrow reserve.

Keywords: Spinal pain palliation, metasta-sis, targeted radionuclide therapy.