Bone pain is only a symptom. Pain sometimes appears alone and sometimes with other symptoms. Bone pain makes a person anxious and depressed which is worse than the pain. Bone pain seriously interferes with a person’s normal quality of life. Most pain is due to inflammation of the nerve-sensitive covering (periosteum) on the outside of the bone. Bones of the spine (vertebrae) cause the most pain because there are enough nerves. In some cases, bone loss (eg, osteomalacia) and bone loss (eg, osteonecrosis) puts pressure on the inner lining of the bone (endosteum). The result is severe pain. Different diseases cause pain in different bones with different symptoms. In osteoarthritis, excess bone causes pain through irritation of the outer sensory lining. Joint synovitis causes pain in nearby bones. Also joint instability (dislocation or tendency to dislocate) and internal misalignment (muscle, ligament and meniscus injuries) extend pain to nearby bones. If the bone pain is accompanied by physical weakness and weight loss, it should be understood that the patient is suffering from cancer. In addition to primary bone cancer, cancers of the lung, thyroid gland, breast, kidney, and prostate spread to the bone and cause severe pain. If a child has bone pain, he may be suffering from rickets (calcium and vitamin D deficiency). Bone pain with fever is more likely to cause infection. Osteoporosis causes pain and fractures at the slightest trauma. Bones in a patient with osteomalacia are soft, bendy, and painful. Pain for stress fractures in the leg (tibia) bone occurs after overexertion, sports, training, and walking and running.
Causes of bone pain:
1. Bone injuries and fractures.
2. Infection (septic and TB).
4. Tumors and cancer (osteosarcoma).
5. Deficiency of calcium and vitamins D and C.
6. Rheumatic fever.
7. Joint muscles, ligaments, capsule and meniscus injuries.
8. Rheumatoid, gouty, osteo, infective and inflammatory arthritis.
9. Blood deficiency (sickle cell anemia) and blood cancer (leukemia).
10. Osteoporosis and Osteomalacia.
11. Hyperparathyroidism and hypercalcemia.
12. Paget’s disease.
13. Multiple myeloma.
15. Leptospirosis and Aspergillosis.
16. Smoking and drinking.
At the beginning of the treatment the pain should be known in which bone the pain originates – arm, lower arm, hand, spine, leg or ankle bone. Know more when the pain first started? How long is the pain? Is the pain increasing? What are the symptoms other than pain? Finding the exact cause and providing the necessary treatment can be beneficial in curing bone pain. In addition to physical examination, various blood tests, urine tests, bone marrow tests, X-ray, BMD, bone scan, CT scan and MRI should be done to diagnose the cause of pain. Physical activity makes bones strong and strong. As a result, bone pain is reduced. Appropriate exercise such as regular walking, jogging, climbing stairs and weight bearing strengthens and strengthens bones. Physical activity during adolescence increases bone mass and makes bones thicker, stronger and stronger. As a result, bone pain and fractures are reduced in old age. A balanced diet and a daily intake of 1300 mg of calcium for adolescents, 1000 mg for 50 years and 1200 mg for over 50 years of age. Smoking and drinking should be avoided. Consuming adequate amounts of calcium and vitamins C and D can prevent and relieve bone pain. Moderate calcium and vitamin D and bisphosphonate (alendronate, etidronate, and risedronate) intake, hormone replacement therapy, and calcitonin injection push may be needed to compensate for bone loss. In addition to pain medication, chemotherapy, radiotherapy, surgery and arthroscopic treatment and other medications may be used for the primary cause.
Author: Dr. G. M. Jahangir Hossain, Assistant Professor, Department of Orthopedic Surgery, National Orthopedic Hospital and Institute of Rehabilitation (NETOR), Dhaka