ABSTRACT
Bone is the third most common metastatic site after lungs and liver in advanced stages of cancer. Bone pain may be caused by local compression and/or invasion of the tumor or a pathological fracture due to bone metastasis. The mainstay of pain management is the treatment of underlying cancer. Furthermore, in case of pathologic fracture, surgery and/or radiotherapy may be considered. Besides, analgesics might be needed in most of the cases. Opioid analgesics are the backbone for the management of cancer pain. Nevertheless, paracetamol and nonsteroidal anti-inflammatory agents may be combined with opioid analgesics for the control of cancer pain. Adjuvant analgesics which are used as an analgesic due to their secondary effects are another option for the management of bone-related pain. Bisphosphonates and denosumab which are osteoclast inhibitors are used as an adjuvant analgesics, too. Furthermore, steroids are used as an adjuvant analgesic due to their anti-inflammatory effects.
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