Bone is a common site for metastatic carcinoma. Pain is the most common symptom of bone metastases. Radiation therapy (RT) is an effective method of palliative treatment of painful bone metastases. The main aim of RT are pain relief and prevention of skeletal complications. Analgesic effect is achieved in 50-80% of patients and complete response rate was 20-50%. Numerous randomized trials and meta-analyses confirmed similar results in achieving pain relief with single dose and multiple fraction RT schedules. However significantly higher re-treatment rate with single dose RT was evident. Many present guidelines recommend single fraction RT as a standard for painful bone metastases. Multiple fraction schedules are more effective in neuropathic pain associated with bone metastases, longer life expectancy and risk of pathologic fracture.