Bone Pain

Bone pain is a fairly common symptom. Bone is a very metabolically active organ that is in constant reconstruction and change. Bone remodeling is a dynamic process that responds to actual load of human body. In addition, bones are an important site of hematopoiesis (in bone marrow). There are numerous pathological conditions associated with bone pain.

Causes

Osteoarthritis

This condition manifests with joint and bone pain. It is probably the most common cause for complaints of bone pain in the elderly, the obese and hard manually-working people. The primary problem lies in progressive joint destruction and irritation of neighboring bones occurs secondarily.

Osteoporosis

Decalcification of bones reduces their strength and physical exertion may become painful. Osteoporosis is a common disease by the elderly, particularly by women after menopause, when levels of female sex hormones decrease.

Paget's disease

It is probably the second most common metabolic bone disease after osteoporosis. Its cause is not clear. The disease affects many people, but it has symptoms only in a relatively little group. Severe forms of the disease cause serious impairment without proper treatment.

Infectious osteomyelitis

Acute bone infection is usually associated with strong pain and fever. It may be a complication of orthopedic surgical interventions or a complication of sepsis.

Injuries

Bone contusions and fractures are painful. Doctors of internal medicine are especially interested in so-called pathological fractures. Pathological fractures occur by abnormally weak external force. For more details about this phenomenon I recommend to read relevant article.

Leukemia

These malignant blood diseases can manifest by pain long bones, typically by bones of lower extremities. It is connected with infestation of bone marrow by tumor cells. Bone pain is typical especially for CML and ALL.

Growth pain

This type of bone pain occurs in children and adolescents. These life periods are times of accelerated bone growth. Pain occurs mainly in lower extremities and usually in the evening and at night (i.e. at rest). There is some similarity with bone pain caused by leukemia. Therefore it is necessary to have in mind that growth pain should not be accompanied by any other symptoms, especially not by elevated temperature and night sweating. Likewise, any swelling, redness or deformations of body parts do not support the diagnosis of growth pain.

Bone Cancer

Various forms of malignant tumors are derived from the bone and surrounding cartilage tissue (and very specific type of tumor known as Ewing's sarcoma). They are often associated with pain. This group of tumors is rather typical for individuals about 20 years of age and they have in general bad prognosis.

Metastases

Many malignant tumor spread into bones, it is very common by prostate cancer, breast cancer, kidney cancer and lung cancer. Bone metastases are usually painful and sometimes they give rise to pathological fractures. Radiation therapy has usually great analgesic effect in such circumstances.

Multiple myeloma

This malignancy is based on abnormal proliferation of some white blood cells that produce antibodies. Tumor cells invade some bones, especially pelvis, skull and ribs. For more information, see text dedicated to multiple myeloma.

Diagnostic approach

Medical history should be completed in the beginning. Most important is information about the nature of pain, its duration, causative situations, etc. The patient should inform his or her doctor about any other diseases, in particular about any cancer disease in the past.

Physical examination should focus on observation and palpation of the location of pain. Local redness, swelling, palpable mass or deformation are significant findings. Blood tests are particularly important in metabolic bone diseases and blood cancers. In blood we may diagnose increased concentrations of substances produced during the breakdown of bones, or changes in blood cell counts. Imaging methods are important as well. Classical X-ray is the cheapest and most accessible of them all. In case of detected abnormalities, computed tomography or magnetic resonance imaging may be carried out. The entire skeleton and its metabolic activity are investigated by an examination known as bone scintigraphy. Bone density is measured using a densitometer to rule out decalcification like in osteoporosis. Other more specialized tests are performed according to results of above mentioned diagnostic methods.