Bone metastases occur in up to 85% of patients (at autopsy) who have breast, lung, and prostate cancer, and are a common cause of pain and neurological morbidity in patients with these and other cancers. The management of pain, the most common complication of bone metastasis, requires a knowledge of specific clinical syndromes and the associated neurological and orthopedic morbidities, as well as an understanding of current antitumor and pharmacological therapies. Knowledge of these potential complications are important in the design of clinical trials that seek to evaluate the effectiveness of new treatments for bone metastasis. Although radiation therapy in combination with analgesic drug therapies remains the mainstay of treatment, much recent interest in drugs with specific effects on bone elements, especially the osteoclast, offer the promise of providing effective pain relief with fewer side effects than is currently possible with conventional therapies.