Bone pain
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Ostealgia; Osteodynia.
Overview
Bone pain is a debilitating form of pain emanating from the bone tissue. It occurs as a result of a wide range of diseases and/or physical conditions and may severely impair the quality of life for patients who suffer from it.[1] Bone pain has multiple causes, such as extensive physical stress and diseases such as cancer.[2][3] For many years it has been known that bones are innervated with sensory neurons. Yet their exact anatomy remained obscure due to the contrasting physical properties of bone and neural tissue.[4] However, until recently, it was not determined what types of nerves innervated which sections of bone.[5] The periosteal layer of bone tissue is highly pain-sensitive and an important cause of pain in several disease conditions causing bone pain, like fractures, osteoarthritis, etc. However, in certain diseases the endosteal and haversian nerve supply seems to play an important role, e.g. osteomalacia, osteonecrosis, and so on.[6] Thus there are several types of bone pain, each with many potential sources or origins of cause.
Pathophysiology
Stimulation of specialized pain-sensitive nerve fibers (nociceptors) that innervate bone tissue leads to the sensation of bone pain. Bone pain originates from both the periosteum and the bone marrow which relay nociceptive signals to the brain creating the sensation of pain. Bone tissue is innervated by both myelinated (A beta and A delta fiber) and unmyelinated (C fiber) sensory neurons. In combination, they can provide an initial burst of pain, initiated by the faster myelinated fibers, followed by a slower and longer lasting dull pain initiated by unmyelinated fibers.[3][5]
Nociceptors responsible for bone pain can be activated via several mechanisms including deterioration of surrounding tissue, bone destruction,[1] and physical stress which shears the bone, vascular, muscle, and nervous tissue.
Bone Cancer
Bone cancer is one of the most serious forms of pain. Because of its severity and uniqueness with respect to other forms of pain, it is extensively researched. According to studies of bone cancer in mouse femur models, it has been determined that bone pain related to cancer occurs as a result of destruction of bone tissue. Chemical changes that occur within the spinal cord as a result of bone destruction give further insight into the mechanism of bone pain.[1]
Metastatic cancer cells often aim to establish themselves within the skeleton. When the cancer cells have metastasized, the mechanical dynamics of the bone matrix become weaker as skeletal strength decreases. This leads to several other complications throughout the body including pain, thus decreasing the patient’s quality of life.[7]
Bone tumors are composed of a conglomeration of cell types including cancer and immune system cells. Oftentimes tumor cells secrete growth factors which activate receptors close to primary afferent neurons. Activation of these neural receptors is a contributing factor to pain sensation. Additionally, inflammatory lipids called prostaglandins, which are produced at high rates by cancer cells within tumors, activate nociceptors when they bind together.[3]
Diseases affecting bones
- viral illness (such as a cold that has spread to the bones/joints)
- leukemia (blasts that have surfaced to the top of the bone, often with tenderness)less common)
- blood infection (anemia/other)
- trauma to the bone (such as a fall)
- arthritis pain
- weather changes
- fibromyalgia (widespread body pain with tenderness)
- Cancer - can be primary bone tumor or spread from another cancer known as a Bony metastasis.
- Paget's disease
- Osteoporosis
Differential Diagnosis of Causes of Bone pain
In alphabetical order. [8] [9]
- Acute leukemia
- Asceptic bone necrosis
- Benign bone tumor
- Breast Cancer
- Brodie's Abscess
- Bronchial carcinoma
- Cystic subcartilaginous osteolyses
- Drugs
- Fibrous dysplasia
- Fractures
- Fractures without appropriate trauma
- Gaucher's Disease
- Hypernephroma
- Jaffe-Lichtenstein Syndrome
- Malignant bone tumor
- Metastases
- Multiple Myeloma
- Osteomalacia
- Osteomyelitis
- Osteoporosis
- Other injuries
- Paget's Disease
- Polio
- Primary/secondary hyperparathyroidism
- Prostate Cancer
- Renal osteopathy
- Sickle Cell Anemia
- Syphilis
- Thyroid Cancer
- Tuberculosis
- Vitamin C deficiency
Prognosis
The bone pain will most likely stop if the cause is identified.
References
- ↑ 1.0 1.1 1.2 Luger, N. Mach, D. Sevcik, M. Mantyh, P. (2005). Bone cancer pain: From mechanism to model to therapy. Journal of Pain and Symptom Management. 29(5): 32-46.
- ↑ Zwas, T. Elkanovitch, R. George, F. (1987). Interpretation and Classification of Bone Scintigraphic Findings in Stress Fractures. Journal of Nuclear Medicine. 28: 452-457.
- ↑ 3.0 3.1 3.2 Mantyh, P. Clohisy, D. Koltzenburg, M. Hunt, S. (2002). Molecular Mechanism of Cancer Pain. Nature Reviews: Cancer. 2: 201-209.
- ↑ McCredie J (2007). Nerves in bone: the silent partners. Skeletal Radiology. 36: 473–475.
- ↑ 5.0 5.1 Mach, D. Rogers, S. Sabino, M. Luger, N. Schwei, M. Pomonis, J. Keyser, C. Clohisy, D. Adams, D. O’leary, P. Mantyh, P. (2002). Origins of skeletal pain: Sensory and sympathetic innervation of the mouse femur. Neuroscience. 113(1):155-166.
- ↑ "Bone Pain Causes, Symptoms, and Treatment".
- ↑ von Moos, R. Strasser, F. Gillessen, S. Zaugg, K. (2008). Metastatic bone pain: treatment options with an emphasis on bisphosphonates. Supportive Care in Cancer. 16(10): 1105-1115.
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
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