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Metastatic bone pain: treatment options with an emphasis on bisphosphonates

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Abstract

Introduction

One of the key targets for metastatic cancer cells is the skeleton. Once metastatic cells are established within the bone matrix, skeletal integrity becomes increasingly compromised. Bone lesions lead to various complications, including bone pain, fractures and spinal cord compression.

Mechanisms of bone pain

Bone pain is debilitating and affects quality of life of the patient. In addition, it increases the use of health care resources. Many patients with metastatic bone disease experience substantial bone pain despite state-of-the-art systemic analgesic treatment. Incident pain is the predominant pain syndrome.

Treatment options for bone pain

Typically, this syndrome requires moderate baseline analgesia with increased on-demand doses. Other techniques for treating bone pain, including radiation therapy, neuraxial application of analgesics, nerve blocks and local stabilisation procedures, should be considered. In addition, therapy with bisphosphonates targeting bone-specific pain is an important strategy. This review discusses the various management options for bone pain arising from metastatic bone disease.

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Acknowledgment

Professional editorial assistance for this manuscript was provided by Gardiner-Caldwell US and funded by an unrestricted educational grant by Roche.

Conflict of interest statement

Dr. Roger von Moos has a consultant or advisory relationship with Roche and Novartis.

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Authors and Affiliations

  1. Medical Oncology, Kantonsspital Graubünden, Loestrasse 170, Chur, 7000, Switzerland

    Roger von Moos

  2. Palliative Medicine Section Oncology, Department of Internal Medicine, Kantonsspital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Florian Strasser

  3. Department of Radiation Oncology, University Hospital, Rämistrasse 100, 8091, Zurich, Switzerland

    Kathrin Zaugg

  4. Oncology–Haematology, Kantonsspital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Silke Gillessen

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  1. Roger von Moos
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  2. Florian Strasser
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  3. Silke Gillessen
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  4. Kathrin Zaugg
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Correspondence to Roger von Moos.

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von Moos, R., Strasser, F., Gillessen, S. et al. Metastatic bone pain: treatment options with an emphasis on bisphosphonates. Support Care Cancer 16, 1105–1115 (2008). https://doi.org/10.1007/s00520-008-0487-0

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  • DOI: https://doi.org/10.1007/s00520-008-0487-0

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