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Bone pain

Bone pain (also known medically by several other names) is pain coming from a bone, and is caused by damaging stimuli. It occurs as a result of a wide range of diseases or physical conditions or both, and may severely impair the quality of life.[1]

Bone pain belongs to the class of deep somatic pain, often experienced as a dull pain that cannot be localized accurately by the patient. This is in contrast with the pain which is mediated by superficial receptors in, e.g., the skin. Bone pain can have several possible causes ranging from extensive physical stress to serious diseases such as cancer.[2][3]

For many years[when?], 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] More recently,[when?] it is becoming clear what types of nerves innervated which sections of bone.[5][6] 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. in osteomalacia, osteonecrosis, and other bone diseases.[citation needed] Thus, there are several types of bone pain, each with many potential sources or origins of cause.

Causes edit

A number of diseases can cause bone pain, including the following:

Causes in children edit

Common causes of bone and joint pain in adults, such as osteoarthritis and gouty arthritis are rare in children, as these diseases are a sequelae of chronic wear and tear for several years.

Cancer edit

Pain caused by cancer within bones is one of the most severe 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 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.[17]

Bone tumors are composed of a conglomeration of cell types, including cancer and immune system cells. Often, tumor cells secrete growth factors that 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]

Pathophysiology edit

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.

Treatment edit

The use of anesthetics within the actual bone has been a common treatment for several years. This method provides a direct approach using analgesics to relieve pain sensations.[4]

Another commonly used method for treating bone pain is radiotherapy, which can be safely administered in low doses. Radiotherapy utilizes radioactive isotopes and other atomic particles to damage the DNA in cells, thus leading to cell death. By targeting cancer tumors, radiotherapy can lead to decrease in tumor size and even tumor destruction.[18] A form of radiotherapy that is often used in cases of bone cancer is systemic radioisotope therapy, where the radioisotopes target sections of the bone specifically undergoing metastasis.

In the case of bone fractures, surgical treatment is generally the most effective. Analgesics can be used in conjunction with surgery to help ease pain of damaged bone.[18]

Research edit

Mouse and other animal models are being heavily used to determine the neuron tissue densities in bone[5] and mechanisms for maintenance of bone pain.[1] This information is pertinent to determining the biological and physiological components of pain in the bone. By creating a detailed map relating the types of nerves going through the different sections of bone, it is possible to pin-point locations in the bone that are at a higher risk of being susceptible to bone pain.[citation needed]

Treatments focusing on biological components such as cannabinoid receptors are being tested for effectiveness. Through testing in mouse models, it has been shown that activation of the CB-1 receptor helps reduce reactions associated with acute pain, indicating that it alleviates bone pain. Thus, a new target for potential treatments is activation of the CB-1 receptor.[19]

Modern research and techniques are attempting to provide longer-lasting and more effective methods of treating bone pain by developing and applying new physiological knowledge of nervous tissue within the bone. If thorough understanding of the intra-neuronal mechanisms relating to pain can be developed, then new and more effective treatment options can be created and tested. Thus, it is critical to fully understand the mechanism which dictates bone pain.[citation needed]

Names edit

Bone pain is also known by the following names:

Name Pronunciation Derivation
ostalgia /ɒstˈælə/ ost- + -algia
ostealgia /ɒstiˈælə/ oste- + -algia
osteodynia /ɒstiˈdɪniə/ osteo- + -dynia

References edit

  1. ^ a b c d 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.
  2. ^ 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. ^ a b c Mantyh, P. Clohisy, D. Koltzenburg, M. Hunt, S. (2002). Molecular Mechanism of Cancer Pain. Nature Reviews Cancer. 2: 201-209.
  4. ^ a b McCredie J (2007). Nerves in bone: the silent partners. Skeletal Radiology. 36: 473–475.
  5. ^ a b c 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.
  6. ^ Falk S, Uldall M, Heegaard AM. (2012). The role of purinergic receptors in cancer-induced bone pain. J Osteoporos. 2012;2012:758181. doi: 10.1155/2012/758181
  7. ^ a b c d e f g h i j k Mantyh PW (2014). "The neurobiology of skeletal pain". Eur J Neurosci (Review). 39 (3): 508–19. doi:10.1111/ejn.12462. PMC 4453827. PMID 24494689.
  8. ^ a b Leffler DA, Green PH, Fasano A (Oct 2015). "Extraintestinal manifestations of coeliac disease". Nat Rev Gastroenterol Hepatol (Review). 12 (10): 561–71. doi:10.1038/nrgastro.2015.131. PMID 26260366. S2CID 15561525.
  9. ^ Aziz I, Hadjivassiliou M, Sanders DS (Sep 2015). "The spectrum of noncoeliac gluten sensitivity". Nat Rev Gastroenterol Hepatol (Review). 12 (9): 516–26. doi:10.1038/nrgastro.2015.107. PMID 26122473. S2CID 2867448.
  10. ^ a b c d e f g Junnila JL, Cartwright VW (2006). "Chronic musculoskeletal pain in children: part II. Rheumatic causes". Am Fam Physician. 74 (2): 293–300. PMID 16883927.
  11. ^ Buskila D, Ablin J (2012). "Pediatric fibromyalgia". Reumatismo (Review). 64 (4): 230–7. doi:10.4081/reumatismo.2012.230. PMID 23024967.
  12. ^ Uziel Y, Hashkes PJ (2007). "Growing pains in children". Pediatric Rheumatology Online Journal. 5: 5. doi:10.1186/1546-0096-5-5. PMC 1869025. PMID 17550631.
  13. ^ a b c d e f Junnila JL, Cartwright VW (2006). "Chronic musculoskeletal pain in children: part I. Initial evaluation". Am Fam Physician (Review). 74 (1): 115–22. PMID 16848385.
  14. ^ a b c d e Ajdinovic B, Jaukovic L, Antoniou D (2013). "Five benign myoskeletal diseases in paediatrics and the role of nuclear medicine. Do they differ from those in adults?". Hell J Nucl Med. 16 (1): 2–8. PMID 23529387.
  15. ^ Hazzazi MA, Alzeer I, Tamimi W, Al Atawi M, Al Alwan I (2013). "Clinical presentation and etiology of osteomalacia/rickets in adolescents". Saudi Journal of Kidney Diseases and Transplantation. 24 (5): 938–41. doi:10.4103/1319-2442.118087. PMID 24029258.
  16. ^ "Septic Arthritis". The Lecturio Medical Concept Library. Retrieved 27 August 2021.
  17. ^ 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.
  18. ^ a b Mercadante, S. (1997). Malignant bone pain: Pathophysiology and treatment. Pain. 69(1-2):1-18.
  19. ^ Furuse, S. Kawamata, T. Yamamoto, J. Niiyama, Y. Omote, K. Watanabe, M. Namiki, A.(2009). Reduction of Bone Cancer Pain by Activation of Spinal Cannabinoid Receptor 1 and Its Expression in the Superficial Dorsal Horn of the Spinal Cord in a Murine Model of Bone Cancer Pain. Anesthesiology. 111: 173–86.

bone, pain, ostalgia, redirects, here, nostalgia, german, democratic, republic, ostalgie, also, known, medically, several, other, names, pain, coming, from, bone, caused, damaging, stimuli, occurs, result, wide, range, diseases, physical, conditions, both, sev. Ostalgia redirects here For nostalgia for the German Democratic Republic see Ostalgie Bone pain also known medically by several other names is pain coming from a bone and is caused by damaging stimuli It occurs as a result of a wide range of diseases or physical conditions or both and may severely impair the quality of life 1 Bone pain belongs to the class of deep somatic pain often experienced as a dull pain that cannot be localized accurately by the patient This is in contrast with the pain which is mediated by superficial receptors in e g the skin Bone pain can have several possible causes ranging from extensive physical stress to serious diseases such as cancer 2 3 For many years when 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 More recently when it is becoming clear what types of nerves innervated which sections of bone 5 6 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 in osteomalacia osteonecrosis and other bone diseases citation needed Thus there are several types of bone pain each with many potential sources or origins of cause Contents 1 Causes 1 1 Causes in children 1 2 Cancer 2 Pathophysiology 3 Treatment 4 Research 5 Names 6 ReferencesCauses editA number of diseases can cause bone pain including the following Endocrine such as hyperparathyroidism osteoporosis kidney failure 7 Gastrointestinal or systemic such as celiac disease and non celiac gluten sensitivity both often occur without obvious digestive symptoms inflammatory bowel disease including Crohn s disease and ulcerative colitis 7 8 9 Hematologic such as Cushing s syndrome histiocytosis multiple myeloma and sickle cell anaemia 7 Infectious such as Lyme disease and osteomyelitis 7 Neurological such as spinal cord injury and vertebral degeneration 7 Oncologic such as bone metastasis and leukemia 7 Rheumatic such as ankylosing spondylitis rheumatoid arthritis gout 7 Others such as fractures osteoarthritis Paget s disease of bone also termed osteitis deformans or just Paget s disease 7 Causes in children edit Acute leukemia 10 Acute rheumatic fever a very dangerous disease that can cause permanent cardiac damage 10 Untreated celiac disease which can present without gastrointestinal symptoms 8 Fibromyalgia which affects people of all ages 11 Growing pains 12 Hypermobility syndrome can present with knee or ankle pain 10 Lupus 13 Henoch Schonlein purpura 13 Fibrous dysplasia of bone 7 14 Infection 13 14 Injury such as a fracture 13 14 Inflammatory bowel disease 10 Juvenile idiopathic arthritis 7 13 Legg Calve Perthes disease 14 Lyme disease which is transmitted by ticks and is characterized by debilitating polyarthritis neurologic symptoms and erythema migrans 13 Lymphoma 10 Osteomalacia rickets in adolescents 15 Osteopetrosis 14 Osteosarcoma 10 Rickets 7 Septic arthritis a severe infection of the joint that can lead to permanent joint damage 16 Spondyloarthropathies 10 Viral diseases including the measles influenza mononucleosis chickenpox and mumps citation needed Common causes of bone and joint pain in adults such as osteoarthritis and gouty arthritis are rare in children as these diseases are a sequelae of chronic wear and tear for several years Cancer edit Main article Bone tumor Pain caused by cancer within bones is one of the most severe 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 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 17 Bone tumors are composed of a conglomeration of cell types including cancer and immune system cells Often tumor cells secrete growth factors that 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 Pathophysiology editStimulation 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 Treatment editThe use of anesthetics within the actual bone has been a common treatment for several years This method provides a direct approach using analgesics to relieve pain sensations 4 Another commonly used method for treating bone pain is radiotherapy which can be safely administered in low doses Radiotherapy utilizes radioactive isotopes and other atomic particles to damage the DNA in cells thus leading to cell death By targeting cancer tumors radiotherapy can lead to decrease in tumor size and even tumor destruction 18 A form of radiotherapy that is often used in cases of bone cancer is systemic radioisotope therapy where the radioisotopes target sections of the bone specifically undergoing metastasis In the case of bone fractures surgical treatment is generally the most effective Analgesics can be used in conjunction with surgery to help ease pain of damaged bone 18 Research editMouse and other animal models are being heavily used to determine the neuron tissue densities in bone 5 and mechanisms for maintenance of bone pain 1 This information is pertinent to determining the biological and physiological components of pain in the bone By creating a detailed map relating the types of nerves going through the different sections of bone it is possible to pin point locations in the bone that are at a higher risk of being susceptible to bone pain citation needed Treatments focusing on biological components such as cannabinoid receptors are being tested for effectiveness Through testing in mouse models it has been shown that activation of the CB 1 receptor helps reduce reactions associated with acute pain indicating that it alleviates bone pain Thus a new target for potential treatments is activation of the CB 1 receptor 19 Modern research and techniques are attempting to provide longer lasting and more effective methods of treating bone pain by developing and applying new physiological knowledge of nervous tissue within the bone If thorough understanding of the intra neuronal mechanisms relating to pain can be developed then new and more effective treatment options can be created and tested Thus it is critical to fully understand the mechanism which dictates bone pain citation needed Names editBone pain is also known by the following names Name Pronunciation Derivationostalgia ɒ s t ˈ ae l dʒ e ost algiaostealgia ɒ s t i ˈ ae l dʒ e oste algiaosteodynia ɒ s t i oʊ ˈ d ɪ n i e osteo dyniaReferences edit a b c d 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 a b c Mantyh P Clohisy D Koltzenburg M Hunt S 2002 Molecular Mechanism of Cancer Pain Nature Reviews Cancer 2 201 209 a b McCredie J 2007 Nerves in bone the silent partners Skeletal Radiology 36 473 475 a b c 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 Falk S Uldall M Heegaard AM 2012 The role of purinergic receptors in cancer induced bone pain J Osteoporos 2012 2012 758181 doi 10 1155 2012 758181 a b c d e f g h i j k Mantyh PW 2014 The neurobiology of skeletal pain Eur J Neurosci Review 39 3 508 19 doi 10 1111 ejn 12462 PMC 4453827 PMID 24494689 a b Leffler DA Green PH Fasano A Oct 2015 Extraintestinal manifestations of coeliac disease Nat Rev Gastroenterol Hepatol Review 12 10 561 71 doi 10 1038 nrgastro 2015 131 PMID 26260366 S2CID 15561525 Aziz I Hadjivassiliou M Sanders DS Sep 2015 The spectrum of noncoeliac gluten sensitivity Nat Rev Gastroenterol Hepatol Review 12 9 516 26 doi 10 1038 nrgastro 2015 107 PMID 26122473 S2CID 2867448 a b c d e f g Junnila JL Cartwright VW 2006 Chronic musculoskeletal pain in children part II Rheumatic causes Am Fam Physician 74 2 293 300 PMID 16883927 Buskila D Ablin J 2012 Pediatric fibromyalgia Reumatismo Review 64 4 230 7 doi 10 4081 reumatismo 2012 230 PMID 23024967 Uziel Y Hashkes PJ 2007 Growing pains in children Pediatric Rheumatology Online Journal 5 5 doi 10 1186 1546 0096 5 5 PMC 1869025 PMID 17550631 a b c d e f Junnila JL Cartwright VW 2006 Chronic musculoskeletal pain in children part I Initial evaluation Am Fam Physician Review 74 1 115 22 PMID 16848385 a b c d e Ajdinovic B Jaukovic L Antoniou D 2013 Five benign myoskeletal diseases in paediatrics and the role of nuclear medicine Do they differ from those in adults Hell J Nucl Med 16 1 2 8 PMID 23529387 Hazzazi MA Alzeer I Tamimi W Al Atawi M Al Alwan I 2013 Clinical presentation and etiology of osteomalacia rickets in adolescents Saudi Journal of Kidney Diseases and Transplantation 24 5 938 41 doi 10 4103 1319 2442 118087 PMID 24029258 Septic Arthritis The Lecturio Medical Concept Library Retrieved 27 August 2021 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 a b Mercadante S 1997 Malignant bone pain Pathophysiology and treatment Pain 69 1 2 1 18 Furuse S Kawamata T Yamamoto J Niiyama Y Omote K Watanabe M Namiki A 2009 Reduction of Bone Cancer Pain by Activation of Spinal Cannabinoid Receptor 1 and Its Expression in the Superficial Dorsal Horn of the Spinal Cord in a Murine Model of Bone Cancer Pain Anesthesiology 111 173 86 Retrieved from https en wikipedia org w index php title Bone pain amp oldid 1176437805, wikipedia, wiki, book, books, library,

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