According to the World Health Organization (WHO), musculoskeletal disorders are a serious problem requiring global health care in all regions of the world. An estimated 1.71 billion people worldwide suffer from musculoskeletal disorders. and are the leading cause of disability in virtually all regions.
Low back pain takes the prize in terms of prevalence, affecting some 570 million people at any given time and place, or 10 to 20% of the entire general population. It is expected that 8 out of 10 of us will suffer at some point in our lives an acute episode of low back pain, so as a species, we are more than familiar with the term and symptomatology of back pain.
However, the reality is that there are more than 150 disorders that affect the locomotor system at the medical level.. Lumbago is one of them, but fibromyalgia, osteoporosis, osteoarthritis, certain metabolic problems and even some types of cancer can manifest themselves with muscle and/or bone pain. Today we focus on the “hard” part of this whole system, as we bring you the causes, symptoms and treatment of bone pain. Don’t miss it.
What is bone pain?
Bone pain or bone pain can occur for many specific reasons, such as physical trauma, infections, age-associated pathologies, emotional events or metastatic canceramong other things. In any case, sometimes finding a specific cause of generalized musculoskeletal pain is complex, as there are a number of idiopathic disorders that generate discomfort in the patient for no apparent reason. In order for you to understand what we mean, we present the 3 types of pain that are conceived today:
Nociceptive or peripheral pain: normal neuronal process by which potentially harmful stimuli are encoded. The inflammatory response is an example of this and, in this case, pain is directly proportional to the intensity of the noxious event.
Neuropathic pain: in this case, there is clear damage to central or peripheral nerves. From this point on, the patient feels more pain than he/she should and even harmless stimuli cause pain (allodynia).
Centralized pain: there is no specific damage that causes pain, but it is believed that there is an imbalance in certain neuronal 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 the pain.These nerve bodies are responsible for receiving the harmful signals and sending them to the spinal cord, which end up flowing into brain regions such as the thalamus, central gray matter and others. Beyond this normal response, it should be noted that in animal models neuropathic events involving bone tissue have also been detected and, on rare occasions, there is no cause for the discomfort. Fibromyalgia is a clear example of this.
Causes and treatment of bone pain
It is difficult to cover all the causes of bone pain, since we are dealing with a heterogeneous tissue that varies over time and responds differently in each case to environmental stimuli. However, we present some of the most common triggers, with their possible pharmacological approaches.
Fibromyalgia is defined as a diffuse, generalized and chronic musculoskeletal pain that remains in the patient for at least 3 months for at least 3 months without signs of healing. The patient feels extreme sensitivity (allodynia and hyperalgesia) to normal stimuli, so that bones and muscles ache with varying intensity, but does not know why.
The prevalence of this clinical event in adults stands at 2.4% of the general population, being much higher in women than in men. Juvenile fibromyalgia (JF) is even more common, affecting an estimated 3.7% of boys and 8.8% of girls. Unfortunately, to date, there is no 100% effective treatment in all cases, so the approach must be multidisciplinary.
In the first place, over-the-counter pain reducing drugs (ibuprofen) or, if the pain is excessive, stronger prescription drugs (tramadol) are usually used. In many cases, tricyclic antidepressants are also necessary, as they help the patient to sleep more soundly.Tricyclic antidepressants are also necessary in many cases, as they help the patient to sleep despite his condition and allow him to combat the chronic fatigue he presents. Anticonvulsants have also shown some success in treating patients with neuropathic pain, but this is not true in all cases.
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 the age of 30, is sustained for about 10 years and, unfortunately, from the age of 40 onwards, 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 (bone resorption is very aggressive at menopause) and affects 80% of elderly women over 80 years of age. As you can imagine, these patients are much more prone to hip fractures 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 patients. The goal is to stop the bone from losing consistency and to strengthen it as much as possible.
3. Physical trauma
As in any other tissue, a bone responds with inflammatory mechanisms when it is subjected to a strong blow.This results in pain, bruising, heat and/or redness of the affected area. There are many types of injuries: open, closed, with breakage, without breakage, of the fissure type, of the 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 for a professional to assess the patient’s condition. From rest to surgery, there are multiple approaches.
Osteomyelitis is a sudden or slow-onset infection of the tissue of the bones and/or bone marrow (internal tissue of the 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 itself in them by hematogenous route, i.e. through the blood vessels.
Bone infection causes extreme pain in the long bones, as well as lack of function of the affected limb, fever, tremors, lameness and other clinical events associated with bacterial invasion. Due to the difficulty of access to the bone, treatment is always based on antibiotic therapy (usually vancomycin) which, in this case, can last from weeks to months.
We reserve this possible causative agent for last, as it is not at all common for bone pain to be due to cancer. Bone cancers account for less than 0.2% of all malignant neoplasms, so, with few exceptions, one should not be suspected.so, with few exceptions, one should not be suspected.
However, what is more common is for a metastatic cancer to spread to the bones, due to the anatomical proximity to the tumor site. It is common for breast, kidney, lung and prostate cancers to metastasize to the bones. Recall that a metastatic tumor in a bone structure is not a bone cancer per se, as the cells are the same as those causing the primary tumor.
As you may have noticed, bone pain can have multiple causes. If it is chronic, fibromyalgia and osteoporosis are the first etiologic agents that come to mind, as they have a relatively high prevalence of bone pain.They have 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 in onset and is associated with a specific event, it is possible that the patient is suffering from the effects of a bone injury or infection. A malignant tumor in the bony structures of the body is also a possibility, but is much less common than the above events.