Objectives: Patients with painful bone metastasis treated with palliative radiation therapy (RTH) may require re-irradiation. This work aims at assessing the efficacy and safety of re-irradiation for painful bone metastases using single 8 Gy fractions versus (4 Gy × 5 fractions). Methods: From June 2011 to December 2012, previously irradiated bone metastases were re-irradiated with single 8 Gy fractions (group I) or, 4 Gy × 5 fractions (group II). Pain management index (PMI) was determined. Pearson’s r correlation coefficient was calculated between negative PMI at presentation and age, ECOG Performance Status, sex, and primary cancer site. Results: Two months after RTH, about one fifth of patients achieved no pain, mild pain in 75.5% of the remaining patients and no patient suffered from severe pain. There was no significant difference (p>0.05) between groups (I and II) regarding pain relief. Negative PMI score, was reduced to from 37% at presentation to 25%, at 2 months follow up. A strong negative association between PMI and performance status (p=0.0057, 95% confidence interval between 0.109 and 0.557) was found. Conclusion: Palliative re-irradiation with either single 8 Gy fraction or with, 4 Gy × 5 fractions was effective and safe in pain relief.