Which cancer-related bone pain pattern should prompt referral?

• A. Persistent, focal, worse at night, with a history of cancer or new systemic symptoms.
• B. Diffuse bone pain that improves with movement.
• C. Pain only after trauma.
• D. Pain that is diffuse and intermittent.

Answer: (A)

Persistent, focal bone pain that worsens at night in someone with a history of cancer or with new systemic symptoms signals possible bone metastasis or a primary bone malignancy. This pattern stands out because malignant bone lesions often produce a localized, steady pain that tends to be worse at night, unlike many benign musculoskeletal pains that are diffuse, activity-related, or improve with movement. The combination of a cancer history or systemic signs (such as weight loss, fever, or malaise) with focal, night-pain strongly elevates concern and warrants prompt referral for imaging and oncologic evaluation to rule out malignancy.

Other patterns described are more typical of benign or non-malignant causes: diffuse bone pain that improves with movement, pain after trauma, or diffuse intermittent pain without systemic symptoms generally align with non-cancer etiologies and do not by themselves mandate urgent cancer referral.