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Bone pain - causes, symptoms and treatment

Bone pain - causes, symptoms and treatment


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Bone pain is well known to many people in acute form because it is a typical accompanying symptom of broken bones or fractures. But the pain of the bones in various diseases can also take a chronic course. The sufferers suffer permanently from bone pain, are often significantly impaired in their mobility and in their everyday life. In the worst case, the symptoms can be hidden from cancer, which is why a medical examination is urgently recommended.

Definition of bone pain

Bone pain is to be understood in the narrower sense only as pain that is registered by the nerves in the bone marrow, the bone skin and the bone matrix. However, it is often extremely difficult for those affected to differentiate between bone pain and complaints such as joint pain or muscle pain. Especially since the pain is also felt in the surrounding tissue - such as the muscles, ligaments and fascia - as part of a fracture, since these are usually also damaged. The colloquial term limb pain includes as a generic term all muscle, joint and bone pain.

Symptoms

Bone pain is usually perceived by those affected as dull, deep-seated pain, which often increases significantly under stress. As a rule, individual bones such as the tubular bones of the thigh, upper arm, ulna or tibia are affected, but theoretically the symptoms can manifest themselves in the entire skeletal system. For those affected, the bone pain as such is often difficult to localize. The bone pain can start suddenly or gradually develop over time and increase continuously. While some sufferers suffer from bone pain only when they are under stress, others also show corresponding symptoms when at rest.

Because of the pain, patients tend to adopt a protective posture, which in turn leads to incorrect loading of the joints, muscles and ligaments. In this way, further pain in the musculoskeletal system can be caused by the bone pain. In addition to the bone pain, various accompanying symptoms can be observed for the various causes of the complaints, which are then explained in more detail in connection with the respective causal diseases.

Causes of bone pain

The immediate causes of bone pain range from so-called growing pains to fractures, bone diseases and metabolic impairments to malignant tumors with metastasis. Bone pain is not to be confused with joint pain, but it can certainly belong to the same clinical picture. For example, hip pain can be observed more frequently in connection with an osteomalacia disease, which in turn can be the cause of bone pain in the thigh area.

Bone diseases as a cause

Various bone diseases can lead to damage to the bone substance and corresponding bone pain, whereby osteoporosis and osteomalacia (rickets in childhood) are certainly the best known. Bone diseases such as aseptic bone necrosis, osteodystrophia deformans and Engelmann syndrome are less common and therefore less well known.

Osteoporosis

Osteoporosis (bone loss) describes a symptom that is characterized by a decrease in bone density and an increased susceptibility to broken bones. Typically, older people are particularly affected, as bone density naturally declines with age. However, osteoporosis can also be a side effect of other diseases such as an overactive thyroid or chronic polyarthritis. Certain medicines are also associated with an increased risk of osteoporosis. be conditioned. Often the osteoporosis initially goes unnoticed, until finally the first fractures occur on what appears to be an irrelevant cause. These are responsible for the sudden onset of bone pain as part of an osteoporosis disease.

Osteomalacia

In osteomalacia (bone softening) there is insufficient mineralization of the bone substance, which leads to an increased proportion of soft bone matrix in the bone structure. The disease is usually caused by a lack of vitamin D and / or calcium deficiency. Persistent dull bone pain is a typical feature of osteomalacia. The pain probably originates from the periosteum. The so-called creeping fractures, which can occur in the context of osteomalacia, also cause considerable pain in the affected bones. Creeping fractures of this type are more common, for example, on the inside of the thigh bone. The osteomalacia patients tend to posture, which significantly increases the risk of further complaints of the musculoskeletal system. Bone softening in children is called rickets.

Aseptic bone necrosis

A so-called aseptic bone necrosis (bone infarction without infection), in which the blood supply to the bone tissue is locally impaired by a vascular occlusion, is also to be mentioned as a bone disease that can lead to considerable bone pain. Then the bone tissue begins to die off due to the lack of oxygen, nutrients and minerals. The damage to the bone substance can take on an extremely different extent. This ranges from imperceptible minimal loss of substance to serious irreversible damage that is associated with considerable bone pain and restricted movement.

Osteodystrophia deformans

Bone pain can also be observed in the case of Paget's disease (Osteodystrophia deformans). This pathological change in the bones mainly affects older people and is characterized in the initial stages by inflammatory processes, which are associated with an increased bone remodeling rate and pain in the bones. The bones start to thicken and deform. The pelvis, leg bones and lumbar spine are increasingly affected. The bone changes may also be visible from the outside. The heat emitted by the skin is often significantly increased in the affected areas or an overheating can be felt on the skin. Since the changes in the bones sometimes put pressure on the nerve pathways, other complaints such as low back or back pain, sciatica pain and muscle tension (e.g. neck tension) are not uncommon in the context of Paget's disease.

Acromegaly

A rare form of bone disease, which can be associated with bone pain, is acromegaly, which is perceptible as an enlargement of the end parts of the body and the so-called acra (body parts furthest from the trunk). Toes and feet, fingers and hands as well as the nose, chin and parts of the face such as eyebrow bulges or cheekbones are particularly affected. Acromelagia is caused by an overproduction of the growth hormone somatotropin, which is why, from a medical point of view, it is assigned to the so-called endocrinological diseases (diseases of the hormone glands). The decisive factor for the course of the disease is whether it begins before or after puberty. Because if the growth joints of the bones are not yet closed when the disease breaks out, those affected show a general increase in length in the form of giant growth instead of the conspicuous enlargement of the body limbs with corresponding changes in body proportions. If the growth plates are already closed when the disease breaks out, the increased concentration of the growth hormone somatotropin in acromelagia elsewhere leads to uncontrolled growth of articular cartilage and tissue structures. As a result, the conspicuous shift in the body proportions of those affected develops. In addition to the bone pain, symptoms such as headache, fatigue, tiredness, increased sweating and a decrease in sexual excitability can be observed as accompanying symptoms due to the disturbances in the hormonal balance. Acromelagia also increases the risk of high blood pressure, diabetes and cardiovascular diseases.

Engelmann syndrome

Another rare cause of bone pain is Engelmann syndrome, which describes an uncontrolled thickening of the bones. The resilience of the bone structure drops significantly. Engelmann syndrome is an inherited disorder that leads to excess bone tissue formation in childhood and can cause corresponding bone pain. Initially, tubular bones such as the tibia, thigh bone, spoke or ulna are usually affected. In the later course of the disease, the symptoms spread to other bones and there are increasing accompanying impairments of the surrounding muscles. In the late stages, the disease may also affect the skull base and lower jaw, which can lead to narrowing of the channels for the cranial nerves. If a nerve is pinched here, neurological deficiency symptoms such as hearing loss, visual disturbances and facial paralysis are impending consequences.

Cancer

Cancer can be mentioned as a possible cause of bone pain, whereby a distinction must be made between bone cancer, for example in the form of a multiple myeloma or osteosarcoma, and the bone metastases that develop in the course of other cancers. Bone metastases are more common in late stage breast and prostate cancer, for example. Based on today's medical knowledge, they are not curable. The bone pain in bone metastases is perceived as particularly strong by the combination of several factors. On the one hand, the formation of metastases leads to compression of the nerves and a reduction in the blood flow, on the other hand, messenger substances are released that initiate inflammatory processes. All three factors can cause bone pain on their own; in combination, they have a fatal effect. There is also an activation of the so-called osteoclasts, which causes an acidic environment in the affected bone, which in turn can lead to pain.

Osteosarcoma affects the bone directly and is characterized by uncontrolled cell growth of the basic bone substance. The bones are increasingly damaged and the patients suffer from considerable pain. There is a risk of metastasis in the lungs. At first, osteosarcomas usually manifest themselves in the long bones near the joints, although younger people can also be affected. Multiple myelomas are another form of cancer that occurs directly in the bone. They are considered to be particularly malignant, affect the bone marrow and lead to an uncontrolled proliferation of the so-called plasma cells, which in turn serve to produce antibodies. The plasma cells cause the bone to dissolve and cause considerable bone pain. The antibodies produced in excess often lead to deposits in the tissue, which in turn can lead to circulatory disorders or impaired kidney function.

Other causes of bone pain

In addition to the diseases that directly affect the bone substance, numerous other factors must be considered as a possible cause of the bone pain. These range from opioid withdrawal to regulation disorders of the parathyroid glands, the vitamin deficiency disease scurvy and chronic kidney failure to acute leukemia.

Hyperparathyroidism

Due to a regulatory disorder of the parathyroid glands, too much parathyroid hormone is formed in what is known as hyperparathyroidism, which leads to increased breakdown of the bone substance. The calcium from the bones is released, which causes demineralization and possibly bone pain. The calcium release in the urine, which is simultaneously reduced by parathyroid hormone, results in a significant increase in the calcium concentration in the blood. In the worst case, this leads to the formation of kidney and gallstones or even inflammation of the pancreas. The typical accompanying symptom in such cases is massive abdominal pain (acute abdominal pain).

Chronic kidney disease

In chronic kidney disease, the bone metabolism is often significantly affected, which can lead to changes in the bone substance and corresponding bone pain. The impairment of the vitamin D metabolism, the simultaneous reduced absorption of calcium via the intestine and the acidification of the blood cause a considerable loss of the bone substance, which is associated with symptoms similar to an osteoporosis disease. In addition to bone pain, chronic kidney problems can cause various other complaints such as high blood pressure, damage to the peripheral nervous system or, in the worst case, fatal heart diseases (coronary heart disease, pericarditis).

Growing pains

Bone pain in children and adolescents is also associated with general growth processes. These so-called growing pains are not based on a detectable disease and they usually only appear as short-term pain that disappears on its own. Although growth is usually painless, some adolescents experience significant bone pain during the growth phase despite lack of physical symptoms. The legs are particularly often affected. Especially at night, those affected are torn from sleep by the unpleasant pain attacks. However, these usually disappeared relatively quickly and those affected do not have any further impairments.

Opioid withdrawal syndrome

If you are addicted to opioids (e.g. heroin), the first signs of withdrawal appear a few hours after the last dose. The withdrawal symptoms usually peak after one and a half to three days and can include symptoms such as hot flashes, excessive sweating, palpitations, goosebumps, loss of appetite, fever, increased heart rate and respiratory rate, diarrhea, nausea and vomiting. Muscle pain and bone pain can also be observed in the lower extremities as a result of opioid withdrawal.

Acute leukemia

Another possible cause of bone pain is acute leukemia (cancer of the blood). In contrast to chronic leukemia, it occurs relatively suddenly and shows extremely different symptoms. General weakness, an increased tendency to bleed, tiny tissue bleeding and increased bruising, can be the first signs. In addition, those affected start to sweat especially at night, show swelling of the lymph nodes and often have an enlargement of the liver and spleen. In addition, bone pain can be added, but this is not an integral part of the clinical picture. Acute leukaemias can lead to patient death within a relatively short time (a few weeks) if treatment is neglected.

Scurvy

A previously widespread cause of cooking pain, which is hardly ever seen in Europe today, is the vitamin deficiency disease scurvy. With a diet without or with only minimal amounts of vitamin C, the first physical symptoms appear after four months at the latest. Those affected tend to bleed gums, are constantly tired and exhausted, suffer from dizziness and have to deal with skin problems. High fever, diarrhea, poorly healing wounds, tooth loss and muscle loss are further characteristics of the vitamin deficiency disease. Bone pain in scurvy is caused by bleeding beneath the periosteum. Overall, the organism is extremely weakened due to the vitamin deficiency disease and extremely susceptible to infectious diseases. In the worst case, scurvy can lead to the death of those affected due to cardiac insufficiency if the vitamin C deficiency persists.

SAPHO syndrome, Erdheim-Chester disease and Langerhans cell histiocytosis

Bone pain can also be caused by very rare diseases such as SAPHO syndrome, histiocytosis X or Erdheim-Chester disease. Although the risk of a corresponding disease is extremely low, these triggers should also be considered if no other causes of the bone pain can be identified. Typical accompanying symptoms in SAPHO syndrome are severe acne, the formation of purulent blisters on the hands and feet, inflammation of the joint capsule, inflammation of the bone marrow (osteomyelitis) and an abnormal increase in the amount of bone (hyperostosis).

Langerhans cell histiocytosis and Erdheim-Chester disease both belong to the group of so-called histiocytoses, which are based on a malfunction of certain cells of the immune system that mainly occur in the connective tissue. Tumor-like tissue changes form that can also affect the skeletal system. Depending on where the histiocytosis is manifested, extremely different symptoms can be observed. Since the skeletal system is affected relatively often, bone pain is one of the more common complaints of Langerhans cell histiocytosis and Erdheim-Chester disease. Infection of other organs (e.g. lungs, liver or spleen) is by no means uncommon in the course of both diseases, although in the worst case this can have fatal consequences. Skin irritation, such as an itchy rash, and fever are also increasingly associated with histiocytosis. Fortunately, the overall spread of Langerhans cell histiocytosis and Erdheim-Chester disease is extremely low.

Diagnosis

At the beginning of the diagnosis, a detailed medical history should be taken in order to narrow down the causes of the bone pain as much as possible. This was followed by a first physical examination with palpation of the painful regions of the body and a superficial examination. Movement tests can also be offered here. X-rays are a commonly used diagnostic method for bone complaints, since here major changes in the bone structure are usually relatively well visible. This applies not only to fractures and various immediate bone diseases, but also, for example, to scurvy. With the vitamin deficiency disease, the bleeding under the periosteum is clearly visible.

To determine more precisely what the changes in the bone structure are, a bone density measurement is carried out if necessary and a tissue sample of the bone (bone biopsy) is taken. A biopsy is also the method of choice when diagnosing tumors. Modern imaging techniques such as computer tomography (CT) or magnetic resonance imaging (MRI) can also provide other important information for the diagnosis. Essential information for assessing the bone pain may also result from the laboratory examination of urine and blood samples from those affected. In this way, chronic kidney disease as well as hyperparathyroidism, osteodystrophia deformans or acute leukemia can be determined relatively clearly.

Therapy

The treatment options for bone pain depend heavily on the triggers of the symptoms. While some diseases that cause bone pain can be completely cured, others cannot be treated to this day. Here the treatment focuses on alleviating the symptoms and reducing the progression of the disease.

Treatment for osteoporosis

Osteoporosis is one of the bone diseases in which to this day no cure, but only a slowdown in the disease process can be achieved. As part of the therapy, an adjustment of the diet to ensure the required calcium intake and the exercise of physical activity to stimulate bone formation are usually recommended. Since vitamin D plays an important role in bone building and is only formed when the skin comes into contact with sunlight, sun rays should also reach the skin at least 30 minutes a day. Taking vitamin D supplements can also be helpful here. In addition, medicines are available that are intended to reduce bone resorption or stimulate bone formation, but these are sometimes associated with considerable side effects and are therefore not without controversy. Possibilities of naturopathic osteoporosis therapy are described below in the section "Naturopathy for Bone Pain".

Therapy for osteomalacia

Since the bone softening is usually due to a lack of calcium or vitamin D, the standard therapy sees an adjustment of the diet to calcium-containing foods (e.g. milk, cheese, kale or broccoli), sufficient sun contact and, if necessary, the intake of calcium and vitamin D supplements. If the osteomalacia is due to a deficiency in phosphate, appropriate use of phosphate preparations is planned. By correcting the deficiency that caused the osteomalacia, the progression of the bone softening and thus the bone pain can be stopped in most cases.

Treatment of aseptic bone necrosis

Aseptic bone necrosis and the associated bone pain can - depending on the extent and location of the complaints - be treated with very different methods. The first thing to do is to protect or relieve the affected bones, which is usually done by immobilization. So-called relief drilling is intended as an invasive procedure for more severe forms of aseptic bone necrosis. Bone transplants and the use of so-called endoprostheses may also be necessary in the case of pronounced bone necrosis. In less serious forms and in the early stages of the disease, hyperbaric oxygen therapy (inhalation of pure oxygen at elevated ambient pressure) is said to have a promising effect.

Treatment for osteodystrophia deformans

In the case of osteodystrophia deformans or Paget's disease, the treatment also focuses on alleviating the symptoms, since healing based on current medical knowledge is not possible. Pain relievers and anti-inflammatory drugs usually form an essential part of conventional medical therapy. At the same time, those affected are often prescribed physiotherapy in order to maintain mobility and to stabilize the musculoskeletal system. Medicines that inhibit the breakdown of bone (bisphosphonates) are also used in the treatment of Paget's disease. The last option is surgical correction of the bones or replacement with a prosthesis.

Acromegaly treatment

Acromegaly usually results from a tumorous event in the pituitary gland, which is countered with surgical removal of the tumor. Drug treatment can be used to prepare for the surgical procedure or after surgical removal has not been completely successful, with the normalization of hormone release taking center stage as part of the medication aftercare. The last treatment option remains radiation therapy, which, however, has considerable side effects and should therefore only be considered if all other therapeutic approaches have been unsuccessful.

Therapy of Engelmann syndrome

Engelmann syndrome is not curable as an inherited disease, but long-term therapy with corticosteroids can bring about a significant relief from the symptoms. However, the therapy may significantly affect the growth of those affected.

Treatment for bone metastases and bone cancer

While there are treatment options for bone cancer diseases, for example in the form of surgical removal, radiation therapy, chemotherapy or stem cell transplantation, which can bring about a cure, bone metastases are generally not curable to this day and the therapy aims at palliative care of the patients. This also applies to radiation and chemotherapy, which may be carried out for bone metastases. Surgical interventions on the affected bones not only offer the possibility to remove the tissue affected by bone metastases for a short time, but in very rare cases, special metastases (renal cell carcinoma) have also been healed in this way.

Treat other causes

Appropriate treatment strategies are used to counter the various other potential triggers of bone pain. The spectrum ranges from a simple change in diet (e.g. for scurvy) to massages for growing pains or drug-assisted opioid withdrawal to surgical interventions (e.g. for hyperparathyroidism) as well as radiation therapy, chemotherapy and stem cell therapy for acute leukemia. Once the cause of the bone pain has been diagnosed, it is usually quite clear what the treatment options look like and what success they promise.

To date, little knowledge is available on the treatment options for extremely rare diseases such as SAPHO syndrome or Erdheim-Chester disease, and a combination of physiotherapy, pain relievers, immunosuppressants, bisphosphonates, certain antibiotics, steroids and interferon is often used here with which to react to the respective symptoms.

Naturopathy for bone pain

Naturopathy has promising treatment options for some potential triggers of bone pain, but in most cases these are only suitable for accompanying therapy. Also, naturopathy can usually hardly counter cancer and hereditary diseases.

In natural medicine, basic nutrition or the balance in the acid-base balance are considered to be of major importance in osteoporosis, since the acidification of the body is responsible for an increased calcium breakdown in the bones. Magnetic therapy is also intended to stimulate bone formation. The same applies to the so-called vibration training, in which the patients stand on a vibrating surface. In addition, the Schüssler salt therapy against bone loss is used, using the Schüssler salts No. 1 (Calcium Fluoratum), No. 2 (Calcium Phosphoricum) and No. 11 (Silicea). Furthermore, various medicinal plants such as horsetail, comfrey or seaweed are used to treat bone pain. Orthomolecular medicine with high-dose vitamin treatment promises relief, especially for disorders of the bone metabolism due to deficiency symptoms. Manual treatment methods such as Rolfing or osteopathy can offer promising accompanying therapy, especially if the musculoskeletal system is impaired by the various bone diseases. Homeopathy uses arnica to relieve acute bone pain, such as occurs in the context of fractures, and Ruta is used as a homeopathic remedy for persistent pain. Symphytum is said to contribute to faster bone healing and calcium phosphoricum is used against delayed bone growth.

Which naturopathic treatment method is used depends largely on the causes of the bone pain and the individual symptoms of those affected. The selection should always be made in close consultation between the therapist and the patient.

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

  • Alexandra Villa-Forte: Pain in the musculoskeletal system, MSD Manual, (accessed October 8, 2019), MSD
  • M. Nathrath, I. Teichert von Lüttichau: Oncological causes of bone pain, monthly pediatrics, issue 7/2009, (accessed October 8, 2019), Springer
  • Andreas Jopp: Risk factor vitamin deficiency, Trias Verlag, 5th edition, 2017
  • C.P. Rader, N. Corsten, O. Rolf: Osteomalacia and Vitamin D Hypovitaminosis, The Orthopedist, Edition 9/2015, (accessed October 8, 2019), Springer
  • Marvin E. Steinberg: Osteonecrosis, MSD Manual, (accessed October 8, 2019), MSD
  • Ian M. Chapman: Gigantism and Acromegaly, MSD Manual, (accessed October 8, 2019), MSD


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