Bone Pain Basics

Christina Lasich, MD Health Pro August 30, 2012
  • Your bones are not dead, static pieces of framework; your bones are alive and can be a source of pain. When you think about bone pain, you might remember a time when you broke a bone. But there are other times when bone pain happens. And when you do experience bone pain, there are some specific treatments to relieve it too.

     

    Let’s first start with the list of catastrophic conditions that can cause bone pain. On top of that list is the most feared of all, cancer. Primary bone cancer or cancer that has spread to the bone (metastatic cancer) is very painful and is the first problem to rule out. Blood test, biopsies and imaging studies might all be necessary to find this sinister cause of bone pain. An equally concerning problem that leads to bone pain is a bone infection (osteomyelitis). In other parts of the world, tuberculosis (TB) is the most common cause of bone infections. But even in parts of the world where TB is almost unheard of, bone infections are not unheard of especially after a surgical procedure or in someone susceptible to infections. The final catastrophic condition that causes bone pain is bone death from a lack of blood supply (avascular necrosis). When the blood supply to the bone is disrupted, the bone dies. People with sickle cell anemia are at risk. So are people that use high-doses of steroids or consume large amounts of alcohol. These catastrophic causes of bone pain are the first problems to rule out when the bone hurts.

     

    The next reasons for bone pain are related to trauma, overuse, bone fragility, and trauma. Of course, the obvious reason for bone pain is a broken bone. Bone fractures are usually easy to detect except when the fracture is very small. The hairline, stress-fractures and micro-fissures that occur from repetitive use, overuse and even everyday use can be very difficult to diagnosis without some very special testing like a bone scan and a MRI. Anyone with osteoporosis or at high risk for fractures should be closely inspected if bone pain is occurring because fractures can be missed. Additionally, anyone taking a bisphosphonate medication who also has bone pain should be closely monitored for a fracture because that bone pain can be an early warning sign. In most cases, bone pain is a warning that something is wrong.

     

    Sometimes that pain is related to abnormalities in bone remodeling, growth and turn-over. For example, abnormally increased bone growth, as seen in conditions like Paget’s disease, are known to cause bone pain.  Parathyroid hormone problems can also cause bone pain. In fact, some think that the bisphosphonate drugs can cause bone pain because of a disruption in the parathyroid hormone balance.1 The next big question is whether or not osteoporosis alone can cause bone pain. The problem with answering that question is the inherent difficulty in detecting micro-injuries to the bone and the confounding side effects from osteoporosis treatments. Osteoporosis might not be quite as silent as we’d like to think.

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    Once the explanation for the bone pain as been revealed, the next step is to treat it. Relieving bone pain is often centered on treating the cause. In order to treat a bone fracture, casts, hardware or cement are used to stabilize the fracture. If cancer is the cause of bone pain, then radiation therapy and chemotherapy can help relieve the pain. Doctors also use steroids to help relieve the excruciating pain caused by a cancerous growth in the bone. And many doctors turn to the bisphosphonate medications to help relieve bone pain caused by cancer2, even though it is ironic because these drugs can also cause bone pain. Calcitonin seems to be falling out of favor as a bone pain treatment3 due to lack of medical evidence. Last but not least, the opioid drugs can relieve bone pain despite the fact that long-term use of opioids can also weaken bones. Treating pain is often not an ideal world.

     

    But when you get down to the bare bone basics about bone pain, this pain signal is really a response to a bone health threat; therefore, bone pain is best treated by improving bone health. Keep your bones as healthy as possible and you’ll be better able to avoid bone pain.

    1. Calcif Tissue Int. 2011 August; 89(2): 91–104
    2. Can Fam Physician. 2008 April; 54(4): 524–527
    3. Cochrane Summaries, Published: Aug. 15, 2012; The Cochrane Collaboration; extracted on Aug. 30, 2012 from: http://summaries.cochrane.org/CD003223/calcitonin-used-to-treat-metastatic-bone-pain
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