Bone Pain

Bone pain is an enfeebling type of pain that emanates from the bone tissues. It can result from a number of causes including normal physical injuries as well as other health conditions and seriously impairs the patient’s quality of life. Bone pain is considered to be a form of deep somatic pain, with the affected individual experiencing a dull pain which cannot be exactly located.

Bone Pain Picture

The exact anatomy of bones remained unknown for many years. Although, bones have been known to be innervated with numerous sensory neurons, the innervation of the exact types of nerves with specific parts of bones has been recently discovered. The periosteal layer present in bone tissues is highly sensitive to pain caused by conditions like fracture and osteoarthritis. The haversian and endosteal nerve supply is responsible for causing the pain in certain bone diseases such as osteomalacia and osteonecrosis. So, bone pain caused by various conditions often has different origins.

Bone Pain Causes

There are numerous potential causes that can lead to this type of pain, including:

  • Bone Cancer (primary malignancy)
  • Decreased blood supply (in diseases like sickle cell anemia)
  • Injury (trauma)
  • Infected bone (osteomyelitis)
  • Overuse
  • Infection
  • Loss of mineralization (osteoporosis)
  • Cancer that has metastasized to the bones
  • Leukemia
  • Toddler fracture
  • Acute rheumatic fever (in children)
  • Acute leukemia (in children)
  • Fibromyalgia
  • Osteosarcoma
  • Hypermobility syndrome
  • Bursitis
  • Septic arthritis
  • Juvenile rheumatoid arthritis
  • Gouty arthritis
  • Lyme disease
  • Synovitis
  • Osteoarthritis
  • Viral diseases like influenza, measles, chickenpox, mononucleosis and mumps

Bone Pain Pathophysiology

The sensation of pain in the bones is triggered by stimulation of nociceptors (nerve fibers specialized for sensing pain) innervated with bone tissues. The pain originated from the periosteum as well as the bone marrow that send the nociceptive signals to brain which leads to the feeling of pain. Both myelinated (the A beta fiber and A delta fiber) and unmyelinated (the C fiber) type of sensory neurons are innervated with all bone tissues. The combined effect of these sensory neurons includes an initial sharp sense of pain (originated by the myelinated fibers) and the slower sensation of a longer lasting milder pain (originated by the unmyelinated fibers).

Nociceptors leading to the pain in the bone can be activated through several mechanisms such as bone destruction, deterioration of the surrounding tissues, acute or chronic trauma and physical stress that shears the bone, muscle and nervous tissues.

Bone Pain Symptoms

The symptoms generally vary depending on the associated condition. Here are some of the most common symptoms of this pain:

  • Aching pain which may or may not radiate from the affected point
  • Tenderness in the affected bone area
  • Numbness
  • Reduced range of movement
  • Redness and swelling
  • Stiffness of the bone joint
  • Limping in case the pain is in a leg bone
  • The surrounding area often become warm to touch

Bone Pain Prevention

One can prevent certain types of pain in bones by avoiding their triggering factors. For example, avoiding overuse of specific bone joints, like the elbow or knee, can keep away pain in these joints. But, there are other types of bone pains that are caused by conditions that are difficult to prevent such as arthritis, bone cancer and osteosarcoma.

Bone Pain Diagnosis

Early diagnosis is necessary to determine the cause of the pain as it may be associated with potentially life threatening conditions such as bone cancer. Sometimes, bone pain caused by sudden injury or trauma can indicate the presence of some more serious underlying conditions. There are certain disorders that make the bone weak and breakable, especially in children. So, individuals with bones that tend to crack at mild blows need to consider medical attention to find out the reason behind the weakness.

Physical examination is one of the most common diagnostic methods for detecting various bone abnormalities. The diagnostician may also ask for the medical history of the patient to look for any previous case of injury. The family history of the affected individual may also be studied by the doctor if some hereditary condition is suspected. Other diagnostic techniques commonly used for the purpose include:

  • X-ray
  • Bone scan
  • Blood tests including blood differential and complete blood count (CBC)
  • CT (computed tomography) scan
  • Magnetic resonance Imaging (MRI)
  • Urine studies
  • Hormone level studies
  • Adrenal and pituitary gland function studies

Bone Pain Differential Diagnosis

It is important for the diagnostician to differentiate the disorder causing the pain from other similar condition. Misdiagnosis is very likely while detecting many of these conditions as they often cause similar symptoms. For example, the symptoms of various metastatic bone diseases can resemble those caused by conditions like Chondrosarcoma, Myeloma, Malignant Lymphoma and Osteomyelitis. Ruling out these conditions is important to decide the proper treatment option for the patient.

Bone Pain Treatment

The best treatment for pain caused by some injury involves taking plenty of rest, applying ice packs on the affected area and sometimes, regular exercise. Physiotherapy is another common treatment option for conditions like Bursitis. Various anesthetic drugs are often used for reducing the pain. Application of anesthetics within the affected bone is another common treatment.

Radiotherapy is also administered in very low doses to patients with metastatic bone diseases for the purpose of pain management. In this therapy, radioactive isotopes are used along with certain other atomic particles for destroying the affected cells to prevent further development of the condition. Systemic radioisotope therapy is a common type of radiotherapy often used for treating bone cancer.

Surgical intervention is sometimes necessary for treating certain bone disorders including fracture. Analgesics are commonly used along with surgery to reduce the pain resulting from the bone damage.

Bone Pain Prognosis

The prognosis varies depending upon the disorder responsible for the pain. There are various other factors, such as the age and overall health of the patient, that shape the outcome of treatment. Some disorders that cause bone pain may lead to serious complications if left untreated for a long period of time.

Bone pain is a common symptom occurring in many curable as well as potentially fatal health conditions. Early diagnosis and proper medical assistance is necessary to determine the source of the pain as some of these disorders may even cause death of the patient if left untreated.

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