Cancer pain is the most common and serious symptom of cancer patients, which seriously affects their quality of life. 14-100% of cancer patients have cancer pain, of which 50-70% are treated; about 90% of patients with bone metastases are troubled by pain. Pain has adverse effects on all aspects of patient’s life, anxiety, distress, personality separation, etc., affecting social function, family and social relationships. Some reports show that in patients with moderate to severe pain, it has affected sleep, activities of daily living, recreation, work ability and socialization. Cancer pain treatment is a key element of comprehensive cancer treatment, and the WHO three-step treatment protocol for cancer pain provides a strong However, it is not well implemented in many countries, especially in developing countries. In Korea, the treatment of cancer pain received little attention before 1990, and it was not until after 2001 that guidelines for cancer pain treatment were developed. In Malaysia, the use of morphine peptides in government surveys is dramatically lower than global levels, and only 24% of cancer pain patients receive regular morphine pain treatment, and the main obstacle is the attitude of doctors and patients toward morphine, with 46% of doctors lacking knowledge about the treatment of severe cancer pain. 64% are worried about side effects such as respiratory depression, and patients are worried about addiction, while Uganda in Africa has allowed nurses to prescribe morphine and has developed its own system that sets a good example. Assessment of pain is a necessary prerequisite for pain control. Current pain assessment methods include visual analog, numerical grading, oral grading and scoring, facial expression, human surface area scoring, etc.; WHO pain grading standards are: grade 0, grade 1, grade 2, grade 3. Cancer pain may come from direct invasion of nerves, bones, soft tissues, ligaments, fascia and expansion or compression through visceral organs, etc. Clinical pain is described by acute, chronic, injurious, visceral and neurological, and comprehensive assessment of the causes, locations and nature of pain is the basis of scientific treatment. 1.Pharmacological treatment Analgesic drugs are the most commonly used means of pain relief in clinical practice. The WHO three-step analgesic principle provides a reliable basis for the pharmacological treatment of cancer pain and is the current guiding principle of clinical medication, the first step: non-opioid adjuvant medication (aspirin or paracetamol); the second step: weak opioid (codeine) + non-opioid adjuvant medication; the third step: strong opioid (morphine) + weak When the drugs in the previous ladder cannot control the pain, the next ladder can be considered until the patient’s pain is relieved. Pain caused by bone metastasis is the characteristic of cancer pain. 70% of cancer pain patients can achieve satisfactory pain relief by using non-steroidal anti-inflammatory analgesics and morphine according to WHO pain relief principles, morphine, oxycodone and phenothaline are the most commonly used opioid analgesics, opioid analgesics are the main drugs for cancer patients to relieve pain, oral morphine is most commonly used in the treatment of severe cancer pain and is preferred. When opioid analgesics are not effective, other effective analgesic measures can be used, including intrathecal injection (subarachnoid and epidural block therapy). Methadone (Methadone) is considered to have a trend of gradually replacing morphine and seems to be more effective compared to other opioids; fentanyl is a synthetic strong opioid that is slowly absorbed into the bloodstream through a patch via the skin, a patch can be used for 3 d, generally in 12~18 h for maximum pain relief, most commonly used in the treatment of cancer pain, passed the US FDA in 1990, by Johnson & Johnson ( Janssen L.P., a subsidiary of Titus-ville, N.J., was released to the market after production. In the treatment of cancer pain, its side effects are less than morphine, it can reduce the incidence of constipation, and it is more effective to shift from small doses of morphine to fentanyl patches than high doses of morphine, and it can relieve delirium when morphine is reduced. Fentanyl patches are indicated for moderate to severe chronic pain and should not be prescribed as a pain medication of choice, only for patients who have used opioids for a period of time, specifically indicated for patients who have taken at least 60 mg of morphine, 30 mg of codeine or 8 mg of hydromorphone or more orally daily and other opioids for one week or more, and are contraindicated in children under 2 years of age; overdose and incorrect use For example: drinking alcohol or taking other drugs that cause brain suppression while wearing a fentanyl patch, anti-AIDS drugs and antifungal drugs, using the next patch without ripping off the previous one, hugging an adult with a patch too closely to a child, being close to a heater, etc. can cause accidents, and side effects often occur in patients with long-term use of the drug, and most of the initial manifestations are not obvious, after long-term use of the drug may develop peptic ulcers, blood platelet dysfunction and nephrotoxicity. After long-term use, gastrointestinal ulcers, platelet dysfunction and nephrotoxicity may occur. In recent years, in-depth studies on the pathophysiological mechanisms of neuroinvasive pain and pain signaling mechanisms have shown that more new drugs can be developed based on the mechanism of interrupting the conduction activities by using ion channels and series of receptors for pain signaling as new targets for pain treatment. Chemotherapy is one of the main treatments for cancer pain, and different cancer pains respond differently to chemotherapy. The complete disappearance of tumor within 1~3 months after chemotherapy is called complete response rate, and disappearance of 50% or more is called partial response rate, and tumors with complete response rate include non-Hodgkin’s lymphoma, ovarian tumor, breast cancer and small cell lung cancer, etc. Cancer pain caused by these tumors can be relieved by chemotherapy, especially local palliative radiotherapy cannot relieve In particular, chemotherapy can be considered for multi-site pain that cannot be relieved by local palliative radiotherapy. Systemic chemotherapy has been shown to prolong the survival of patients with non-small cell lung cancer and small cell lung cancer with bone metastases, and combined platinum-based chemotherapy and newer agents are recommended for patients in good physical condition [15]. However, the choice of chemotherapy should be weighed against the pros and cons of its systemic side effects versus its therapeutic effects. Bisphosphonates are one of the most widely used drugs in patients with bone metastases, inhibiting osteoclast activity and inducing osteoclast apoptosis, effectively inhibiting osteoclast resorption and resorption of bone, as well as affecting tumor cell adhesion, invasion, and proliferation, enhancing the effects of cytotoxic drugs in a synergistic manner, and Sevcik found that bisphosphonates attenuated the upregulated expression of spinal morpholino. Mcc0rmack et al. concluded that ibandronate inhibits osteoclast-mediated bone resorption and effectively prevents bone-related events to improve the quality of life of patients with bone metastases from breast cancer, and is equally effective when administered orally and intravenously.Body et al [19] reported that oral and intravenous ibandronate had the effect of reducing bone-related events and prolonging the time to first bone-related event. Zoledronic acid significantly reduced the incidence of bone metastasis-related events in prostate cancer and improved survival time for up to 24 months [20]. Zoledronic acid is effective in breast cancer, prostate cancer, metastatic lung cancer, renal cell carcinoma, and other solid tumors, and has been shown to be clinically effective in mixed and osteogenic metastases in addition to osteolytic metastases. 2.Surgery Most patients with cancer pain can achieve pain relief through traditional pain medications and adjuvant drugs, but there are still 2-5% of patients with intractable cancer pain. Surgical operation is an important treatment for some cancer pain patients to effectively relieve pain. The indication of surgery depends on the expected effect of surgery, the mortality rate of surgery and the duration of pain relief after surgery. Cancer pain is the main symptom of patients with bone metastases, mainly nocturnal pain, and radicular pain mainly comes from tumor compression, and spinal cord compression occurs in 5%-10% of patients [22], and the symptoms of spinal cord compression include radicular pain, motor impairment, paraplegia, and further destruction can lead to pathological fracture. Spinal tumors occur at different sites and can produce corresponding pain with certain characteristic manifestations. Surgery is one of the main treatments for metastatic spine tumors (MST), and the purpose of surgery is to relieve pain, decompress the spinal cord, restore or preserve neurological function, rebuild spinal stability, and improve the quality of survival. The average survival of all patients was 15.6 months. Guo et al. performed anterior laminectomy spinal structural stability reconstruction in 93 patients with MST, and 87 patients (93.5%) had pain relief and neurological improvement in 47 cases. Alvarez et al. applied PVP to treat vertebral metastases, 90% of patients had immediate pain relief, and nearly 70% of patients resumed their bed activities. Abdominal cancer pain can be controlled by blocking the abdominal plexus collaterals, and it is most commonly seen in pancreatic cancer and cancer pain in the entire upper abdomen. Spinal analgesia (intrathecal or subdural injection) can relieve cancer pain and improve the quality of life for refractory cancer pain analgesia. 3.Radiotherapy Radiotherapy is mostly used for the treatment of pain in bone metastases, and recent studies have shown that a single dose of irradiation can relieve pain after bone metastases in the long term, and the specific mechanism of pain relief is not very clear, one of the mechanisms is through the direct action on tumor cells [29], external irradiation therapy is very effective for bone metastases in relieving bone pain, and it can make pain relief within 48 hours after the start of radiotherapy, and overall If the disease is limited and high-dose radiotherapy is available for a single lesion, external irradiation is the most effective tool, and many studies have attempted to determine the optimal dose fraction for the most effective treatment with minimal side effects. or 2000cGy/5 times or 3000cGy/10 times. In general, higher fractionation doses for lung cancer patients seem to provide better pain relief and longer remission periods. Radionuclides are effective in relieving bone pain caused by bone metastases, especially when multiple lesions need to be treated. 89 strontium, 153 samarium, and 32 phosphorus [31] have been used for most of the experimental results in breast and prostate cancers. 89 strontium is similar to calcium and is mainly distributed in bone tissue, especially in areas where osteoblasts are active. 89 strontium has a half-life of 4 to 5 days and a single dose of 148 MBq. administered by routes other than oral, pain relief is achieved within 7 to 12 hours, and the effect of the drug lasts for an average of 6 months. Samarium 153 is composed of an ethylenediamine tetramethylenephosphonic acid complex (153SMI-EDTMP), and like strontium 89, its enrichment correlates with osteogenic activity. 153SMI-EDTMP has a half-life of 1 to 9 days and is usually administered intravenously, it is characterized by low toxicity and is the most widely used nuclear therapeutic agent for pain relief in the United States, with 83% of patients with bone metastases experiencing pain After treatment, 83% of patients with bone metastases have pain relief. At present, the mechanism of cancer pain has not been fully elucidated, and its pathophysiological mechanism is not completely clear, so that the treatment cannot keep up with it and brings unnecessary pain to patients. The treatment of cancer pain should include chemotherapy, radiotherapy, surgery, pain medication, nerve block, Chinese herbal medicine and cognitive psychotherapy, etc. The key of treatment is to target the etiology of cancer pain causing treatment, such as patients for tumor compression, pathological fracture, invasion of If patients are caused by tumor compression, pathological fracture, invasion of spinal nerve root or intercostal nerve, spinal cord compression, bone metastasis, etc., the effect of pure analgesic drug treatment is not ideal; the treatment of cancer pain should be a multidisciplinary and comprehensive treatment for etiology. Hara [9] believed that tumor bone metastasis is not the end of life, and drug therapy combined with radiotherapy and surgery can relieve pain and improve the quality of life. Cancer pain has been a major factor that seriously affects the quality of life of cancer patients, and how to choose the appropriate treatment measures and individualized treatment plan as a physician is an important step in cancer pain treatment. Making cancer patients pain-free is our goal and the expectation of patients.