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Samarium-153-ethylene diamine tetramethylene phosphonate (samarium-153 EDTMP) is a novel systemic radiopharmaceutical, used for treatment of bone pain due to metastatic disease. We report a patient with carcinoma prostate, diffuse metastatic bone disease with severe back pain that was refractory to analgesics and morphine. He was also found to be anaemic (haemoglobin 8.1 g/dL). Inspite of anaemia and diffuse metastatic bone disease being relative contraindications for the use samarium-153-EDTMP, because of its potential for causing radiation induced myelotoxicity, the patient was treated with this modality and showed a remarkable response in pain control within a few days. He developed mild radiation induced myelotoxicity, which was subsequently managed with blood transfusion and supportive care. The present case highlights the utility of samarium-153 EDTMP therapy in patients with intractable pain due to diffuse metastatic bone disease.