Bone Pain
Bone pain causes discomfort of varying intensity in one or more bones. It is usually continuous and may therefore be disabling for the patient.
Symptoms and Causes
Bone pain is characterized by discomfort or intense pain in one or more bones. It is usually associated with a structural abnormality or a change in bone function resulting from a serious disease.
The characteristics of bone pain differ depending on the underlying cause. While some patients perceive it as continuous, in others it worsens at rest or during movement. Although it is often confused with joint pain, bone pain is more persistent and typically presents as a dull, deep sensation, significantly reducing quality of life.
Bone pain may be accompanied by other symptoms, which vary according to the underlying disease. It is frequently associated with inflammation, local warmth, redness, stiffness, fatigue, and difficulty moving.
Symptoms
The main characteristics of bone pain are as follows:
- Persistent, diffuse, constant discomfort that may be difficult to localize (dull pain).
- Deep quality: it seems to arise from the core of the bone.
- Tenderness to palpation.
- In most cases, it persists continuously, even at rest, thereby interfering with sleep and rest.
Depending on the underlying pathology, bone pain may be accompanied by other signs of disease:
- Inflammation.
- Redness.
- Visible deformity.
- Bone fragility.
- Limited range of motion.
- Fever.
- Fatigue.
- Generalized weakness.
Causes
- Bone pain may be a symptom of:
- Trauma.
- Fractures.
- Fissures (hairline fractures).
- Overuse.
- Bone cancer.
- Metastasis: cancer originating in another organ that has spread to the bones, most commonly from the prostate, lung, breast, thyroid, or kidney.
- Osteomyelitis: infection of the bone and bone marrow, usually caused by staphylococcus.
- Osteoporosis: decreased bone density resulting in bone weakness.
- Leukemia: cancer originating in the bone marrow that affects blood-forming tissues.
- Systemic inflammation: immune response affecting the entire body.
- Systemic lupus erythematosus: chronic autoimmune disease in which the immune system attacks healthy tissues.
- Osteomalacia: demineralization and softening of bone due to mineral deficiency.
- Rickets: weakening, softening, and deformity of bones due to inadequate development.
- Paget's disease of bone: chronic condition causing excessive bone growth, resulting in structurally weaker bones.
- Impaired blood supply to the bones.
- Nutritional deficiencies, such as calcium or vitamin D deficiency.
Risk Factors
- Factors that increase the risk of bone pain, in addition to causative diseases, include:
- Sedentary lifestyle and lack of physical activity.
- Poor posture.
- Repetitive movements or overuse.
- Diet low in calcium (found in dairy products, oily fish, leafy green vegetables, legumes, and nuts) and vitamin D (fatty fish, egg yolk, liver, mushrooms, cheese, and cereals).
- Smoking: reduces blood flow and oxygenation of bone tissue and decreases calcium absorption.
- Alcohol consumption: interferes with the absorption of essential nutrients for bone health, such as calcium and vitamin D. It is a key factor in bone mass loss.
- Obesity: increases pressure on joints, leading to weakening and overexertion that results in inflammation. Joint swelling affects bone structure.
Complications
- Complications associated with bone pain are related to the underlying disease rather than to the pain itself. The most notable include:
- Osteonecrosis: death of bone tissue, usually occurring when blood flow is completely interrupted.
- Recurrent fractures secondary to osteoporosis.
- Septic arthritis: bone infection spreading to the joint.
- Osteoarthritis: chronic joint inflammation.
- Growth disturbances in children.
- Hypercalcemia: elevated blood calcium levels due to bone destruction caused by malignant tumors, metastases, or prolonged immobilization resulting in bone mass loss.
- Spinal cord compression, which may lead to paralysis.
- Muscle mass loss due to disuse.High degree of dependency or disability due to impaired mobility or difficulty performing daily activities.
Which specialist treats bone pain?
Bone pain is managed within the specialties of Rheumatology and Traumatology and orthopedic surgery.
Diagnosis
The diagnosis of conditions causing bone pain usually includes one or more of the following tests:
- Medical history and clinical interview: the specialist gathers information about the patient’s personal and family medical history, as well as lifestyle. The onset, progression, and characteristics of the pain are also assessed.
- Blood tests: help determine rheumatoid factor or detect antinuclear antibodies associated with Systemic lupus erythematosus or rheumatoid arthritis. They also identify hypercalcemia or vitamin D deficiency.
- Urine analysis: excess urinary calcium may indicate osteoporosis, Paget’s disease, or bone metastasis.
- Bone X-ray: provides images of the bones to detect fissures, fractures, tumors, or infections.
- Magnetic resonance imaging (MRI): allows visualization of both bone and soft tissues, enabling identification of tendon, ligament, muscle, or bursal injuries.
- Bone scintigraphy: a radiopharmaceutical is injected that binds to rapidly proliferating cells. As it emits gamma rays to produce images, areas of increased uptake appear brighter, facilitating detection of tumors or infectious foci.
- Bone densitometry: measures the degree of bone mineralization to rule out or confirm osteoporosis.
Treatment
Mild bone pain may be relieved with local application of cold or heat. Moderate pain is treated with analgesics such as paracetamol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs), and severe pain may require opioids.
Diseases causing bone pain require additional therapeutic approaches to achieve cure or, at minimum, symptom control. The most common include:
- Antibiotics for infections.
- Immobilization and rest for fractures.
- Physiotherapy.
- Vitamin supplementation, such as calcium and vitamin D.
- Immunotherapy, chemotherapy, or radiotherapy for bone cancer.
- Surgery to remove tumors, excise bone fragments, or stabilize complex fractures.
