The burden of cancer has become a huge and constantly emerging public health problem that generally continues to receive low priority in Africa, especially in sub-Saharan Africa, even though the incidence of cancer in region has increased significantly. (Kimani et al, 2017). In 2012 alone, according to Parkin et al, 2014), the incidence of cancer in Africa was 6% (847,000 new cases) with a mortality of 591,000 cases, of which 75% of the global burden occurred in Africa sub-Saharan. Prostate cancer in men and breast cancer in women are the most common cancers in the region. Furthermore, it is estimated that over the next decade more than 20 million people will be diagnosed with cancer each year and that more than 70% of global deaths will occur particularly in sub-Saharan Africa and other low-income countries where the 82% of the world's population. lives (Kimani et al., 2017). This increase will therefore require a huge demand for professionals in cancer care and treatment, especially in cancer-induced pain. However, many countries in the sub-Saharan area are not yet prepared to deal with this epidemic. There is therefore a huge unmet need to increase the uptake of cancer screening, early diagnosis, treatment and palliative care services in the region (Zubairi et al., 2017) (Kimani et al., 2017). Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay Data from the 2014 Kenya Demographics and Health Survey also shows that cancer is the second leading cause of death besides cardiovascular disease among non-communicable diseases with a national mortality rate of about 7%. Kenya's 2013 National Palliative Guidelines also estimate that over 28,000 new cases of cancer are diagnosed each year and that 22,100 people die from cancer each year. Additionally, Kenyans under the age of 75 have a 17% risk of getting cancer and a 12% risk of dying from it (Ali, 2016). At Moi Teaching and Referral Hospital, Kenya's second largest hospital, data extracted from the Eldoret cancer registry at Moi University estimated that approximately 5,336 patients were diagnosed with cancer from 1996 to 2006. On average they were Approximately 671 cases of cancer are diagnosed each year. Solid tumors are the most common in the region, accounting for 79% of cancer patients, however a slight difference in the disease pattern was noted. Unlike other places, Ca. esophagus was the most common cancer in the region, while Ca. Cervix and Ca. Prostate were the most common in females and males, respectively. So, therefore, as elsewhere in the world, cancer still represents a huge and significant public health burden in MTRH and in Kenya as a whole. (Tenge, Kuremu, Buziba, Patel, & Were, 2009) On the other hand, however, bone is the third most common site of metastatic disease after the liver and lungs, while the axial skeleton, i.e. the spinal column, is the one most commonly affected. A joaquim 2015 kassamali 2010 These bone metastases still represent a huge and challenging problem in orthopedic oncology, despite advances and innovations in treatment modalities today. Kassamali 2010XX) It is estimated that more than 60-84% of all metastatic cancer patients will eventually develop bone metastases, and more than 40% of these will develop spinal metastases. A joaquim 2015 lee 2011 Each year approximately 5% of cancer patients develop metastases to the spine. kassamali 2010 Spinal metastases are commonly associated with numerous skeletal-related events that primarily include axial or radicular pain,pathological fractures, spinal cord compression and hypercalcemia. These skeletal-related events represent a significant burden of morbidity in patients with spinal metastases and can negatively reduce patients' quality of life and consequently also reduce survival.lee 2011 With advances in cancer treatments, the time Survival is also significantly improved in patients with bone metastases which in return has led to an increase in the number of surviving patients with associated cancer-induced bone pain in the spine. Curtin 2016 laredo 2017 a joaquim 2015 Spinal metastases are more common in elderly patients. The age range of patients with spinal metastases is between 40 and 60 years. Men over the age of 60 are at greater risk of spinal metastases than women in the same age group.max 2003 These are usually patients with advanced breast, prostate, lung and/or kidney cancers which represent approximately 85% of all cases of metastases. happy 2017 This phase usually marks the terminal phase of the disease in which palliative care and pain control represent the best holistic therapeutic approaches. (XXXXX) The role of palliative care here does not have a curative purpose but aims to improve the patient's quality of life, assessment and treatment of pain and physical and spiritual problems. (WHO) Since pain is the most common and important morbidity in cancer patients with spinal metastases xxxxxx, it is therefore important to adequately evaluate and manage pain in these patients because patient survival and improvement in quality of life are states strongly linked to optimal pain and health. Symptom control in cancer patients. (Milgrom 2017) Laredo 2017With advances and innovations in comprehensive cancer care and cancer treatment modalities (i.e. palliative radiation therapy, surgery, chemotherapy) around the world, there has been tremendous improvement in the ability to reduce rates of tumor recurrence, quality of care and life treatment, improve pain control and reduce the need for pain medications. In fact, many cancer patients with metastatic bone disease of the spine are now able to survive for a long time. The median survival for a patient with solitary metastases to the spine is greater than 24 months compared to 3 months for liver metastases. Curtin 2016 happy 2017 However, cancer-induced pain remains the main symptom and cause of morbidity in these kassamali 2017 patients who often receive inadequate management for their pain, which can be devastating to their quality of life. Breast 2013 Metastases to the spine are the most common cause of this pain, and even worse, it is estimated that up to 85% of patients with metastases to the spine suffer from varying degrees of pain. (Milgrom 2017) In 2017 KN Kimani et al reported that a study conducted in Kenya found that many cancer patients suffered from ongoing pain that became increasingly intolerable as the disease progressed and as patients neared the end of life. And despite the fact that there has been increased awareness worldwide about cancer pain, little progress has been made in treating cancer pain. visionNumerous studies have extensively demonstrated the effectiveness of these modalities in the control and treatment of metastatic spine pain and their indications, benefits and limitations discussed in detail. However, few publications have attempted to compare the superiority of these modalities 2012)