Bone pain: possible causes, symptoms and treatment

According to the World Health Organization (WHO), musculoskeletal disorders are a serious problem that requires global health care in all regions of the world. It is estimated that 1,710 million people suffer from this type of pathology on the planet and, furthermore, they are the main cause of disability in practically all regions.

Low back pain takes the prize in terms of prevalence, affecting an estimated 570 million people at any given time and place, or what is the same, from 10 to 20% of the entire population general. 8 out of 10 people are expected to experience an acute episode of low back pain, so as a species, we are more than familiar with the term and symptomatology of back pain. back.

Anyway, the reality is that there are more than 150 disorders that affect the locomotor system at a medical level. Lumbago is one of them, but fibromyalgia, osteoporosis, osteoarthritis, certain metabolic problems and even some types of cancer can manifest with muscle and / or bone pain. Today we focus on the "hard" part of this entire system, as we bring you the causes, symptoms and treatment of bone pain. Do not miss it.

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What is bone pain?

Bone pain or bone pain can occur for many specific reasons, such as physical trauma, infections, age-related pathologies, emotional events, or metastatic cancer., among other things. However, sometimes finding a specific cause for generalized musculoskeletal pain feels like complex, since there are a series of idiopathic disorders that cause discomfort in the patient without a reason apparent. So that you understand what we mean, we present the 3 types of fraud that are conceived today:

Nociceptive or peripheral pain: a normal neural process by which potentially harmful stimuli are encoded. The inflammatory response is an example of this and, in this case, the pain is directly proportional to the intensity of the harmful event. Neuropathic pain: in this case, there is clear damage to the central or peripheral nerves. From here on, the patient feels more pain than he should and even innocuous stimuli harm him (allodynia). Centralized pain: there is no specific damage that causes pain, but it is believed that there is an imbalance in certain neural signaling pathways that trigger it.

At the inflammatory level, it should be noted that the bones of the body are surrounded by specialized nociceptors (those linked to pain)Nerve bodies that are responsible for receiving harmful signals and sending them to the spinal cord, which end up leading to brain regions such as the thalamus, central gray matter, and others. Beyond this normal response, it should be noted that in animal models they have also been detected neuropathic events involving bone tissue and, rarely, there is no cause of the discomfort. Fibromyalgia is a clear example of this.

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Causes and treatment of bone pain

Covering all the causes of bone pain is difficult, since we are dealing with a heterogeneous and time-varying tissue that responds differently in each case to environmental stimuli. Anyway, we present you some of the most common triggers, with their possible pharmacological approaches.

1. Fibromyalgia

Fibromyalgia is defined as a diffuse, generalized and chronic musculoskeletal pain that remains in the patient for at least 3 months with no signs of healing. The patient feels extreme sensitivity (allodynia and hyperalgesia) to normal stimuli, so his bones and muscles ache with varying intensity, but he does not know why.

The prevalence of this clinical event in adults is 2.4% of the general population, being much higher in women than in men. Juvenile fibromyalgia (JF) is even more common, estimated to affect 3.7% of boys and 8.8% of girls. Unfortunately, today, there is not a 100% effective treatment in all cases, so the approach must be multidisciplinary.

First, over-the-counter pain-reducing drugs (ibuprofen) are often used or, if the pain is excessive, stronger prescription drugs (tramadol). In many cases, the consumption of tricyclic antidepressants is also necessary., as they help the patient to sleep despite their condition and allow them to combat the chronic fatigue that they present. Anticonvulsants have also shown some success in treating patients with neuropathic pain, but this is not true in all cases.

2. Osteoporosis

We have the preconception that bones are immovable tissues due to their hardness, but nothing could be further from the truth. 99% of calcium is stored in bone structures, so as you can imagine, bone tissue is continuously synthesized and reabsorbed according to the needs of the individual. Peak bone mass is reached at age 30, is sustained for about 10 years and, unfortunately, From the age of 40, humans begin to lose 0.5% of bone mass per year.

This loss of bone mass causes the bones to become weaker, and they can suffer much more than normal bone structures from any trauma. It is a much more common pathology in women than in men (in menopause bone resorption is very aggressive) and affects 80% of elderly women over 80 years of age. As you can imagine, these patients are much more prone to hip ruptures and life-threatening events associated with mechanical stress.

To prevent the bone from losing its strength, Doctors prescribe calcium and vitamin D supplements, antiresorptive drugs, anabolic agents, and drugs such as Romosozumab to the patients. The goal is for the bone to stop losing consistency and become as strong as possible.

3. Physical trauma

As in any other fabric, a bone responds with inflammatory mechanisms when it takes a strong blow, which results in pain, bruising, heat and / or redness of the affected area. There are many types of injuries: open, closed, with break, without break, fissure type, fracture type, etc. We are not going to dwell on the particularities of these events, but it should be noted that the only Possible treatment in these cases is to go to the emergency room so that a professional can assess the state of the patient. From rest to surgery, the approaches are multiple.

4. Infection

Osteomyelitis is a sudden or slow-onset infection of bone tissue and / or bone marrow. (internal tissue of long bones where all blood cells are produced). The cause of the pathology in 90% of cases is Staphylococcus aureus, a bacterium that can colonize the bones and establish themselves in them by the hematogenous route, that is, through the vessels blood.

Bone infection causes extreme pain in the long bones, in addition to lack of function of the affected limb, fever, tremors, lameness, and other clinical events associated with invasion bacterial. Due to the difficult access to the bone, treatment is always based on antibiotic therapy (vancomycin, generally) which, in this case, can last from weeks to months.

5. Cancer

We save this possible causative agent for last, as bone pain is rarely due to cancer. Bone cancers account for less than 0.2% of all malignanciesSo, with few exceptions, one should not be suspected.

In any case, what is more common is that a metastatic cancer spreads to the bones, due to the anatomical proximity to the tumor focus. It is common for breast, kidney, lung, and prostate cancers to metastasize to the bones. We remember that a metastatic tumor in a bone structure is not a bone cancer per se, since the cells are the same as those that cause the primary tumor.

Resume

As you may have seen, bone pain can have multiple causes. If this is chronic, fibromyalgia and osteoporosis are the first etiological agents that come to mind, as they present a relatively high prevalence in general society, especially in some specific age groups (and in women).

On the other hand, if this pain is acute onset and is associated with a specific event, it is possible that the patient suffers the effects of an injury or infection in the bones. That there is a malignant tumor in the bone structures of the body is also a possibility, but it is much less common than the events mentioned above.