Bone pain - causes, symptoms and treatment

Pain on the bones

Bone pain is well known in acute form to many people, as it is a typical concomitant bone fracture or fracture symptom. But the pain of the bones in various diseases can also assume a chronic course. Those affected suffer permanently from bone pain, are often significantly impaired in their ability to move and in their everyday lives. In the worst case, behind the complaints can hide a cancer, which is why a medical check is advisable.

contents

Definition of bone pain
symptoms
Causes of bone pain
Other causes of bone pain
diagnostics
therapy
Treatment of other causes
Naturopathy with bone pain

Definition of bone pain

In the narrower sense, bone pain refers exclusively to pain registered by the nerves in the bone marrow, the periosteum and the bone matrix. The distinction between bone pain and discomfort such as joint pain or muscle pain is often very difficult for those affected. Especially as part of a fracture, the pain in the surrounding tissue - such as the muscles, ligaments and fascia - are perceived, as 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 a dull, deep-seated pain, which often increases significantly under stress. In this case, individual bones such as the long bones of the thigh, the upper arm, the ulna or the tibia are usually affected, but the symptoms can theoretically manifest in the entire skeletal system. For those affected, the bone pain is often difficult to localize as such. Bone pain can start suddenly or gradually develop over time, increasing steadily. While some sufferers only suffer from pain in the bones under load, others also show corresponding complaints when they are resting.

Due to the pain, the patients tend to take a restraint, which in turn brings strain on the joints, muscles and ligaments. In this way, further complaints of the musculoskeletal system can be caused by the bone pain. In addition to bone pain, a variety of concomitant symptoms can be observed in the various causes of the discomfort, which are explained in more detail in connection with the respective causative disorders.

Osteoporosis is one of the most common causes of bone pain. (Image: Sagittaria / fotolia.com)

Causes of bone pain

The immediate causes of bone pain range from so-called growing pains, fractures, bone diseases and metabolic disorders to malignant tumors with metastasis. Although the bone pain is not to be confused with joint pain, but it can certainly count to the same disease. For example, hip pain is more commonly associated with osteomalacia, which in turn may 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, with osteoporosis and osteomalacia (rickets in childhood) being among the best known. Less common, and therefore less known, are bone diseases such as so-called aseptic bone necrosis, osteodystrophia deformans, and Engelmann syndrome.

osteoporosis
Osteoporosis (bone loss) describes a condition characterized by a decrease in bone density and increased susceptibility to bone fractures. Typically, older people are the most affected because bone density naturally decreases with age. However, osteoporosis may also be a side effect of other diseases such as hyperthyroidism or chronic polyarthritis. The use of certain medicines is also associated with an increased risk of osteoporosis. conditional. Often the osteoporosis goes unnoticed initially, until finally the first fractures occur in seemingly vain occasion. These are responsible for the sudden onset of bone pain in the context of osteoporosis disease.

osteomalacia
In osteomalacia (bone softening), there is no adequate 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 is likely to go from the periosteum. Also cause the so-called creeping fractures, which can occur in the context of osteomalacia, sometimes considerable pain in the affected bones. More often, such creeping fractures show, for example, on the inside of the femur. Osteomalacia patients are prone to relieve pressure, which significantly increases the risk of further musculoskeletal disorders. In children, bone softening is referred to as rickets.

Aseptic bone necrosis
As a bone disease that can lead to significant bone pain, the so-called aseptic bone necrosis (bone infarction without infection) is mentioned, in which the blood supply to the bone tissue is locally affected by a vascular occlusion. Subsequently, the bone tissue begins to die off due to the lack of oxygen, nutrients and minerals. The damage to the bone substance can assume a very different extent. This ranges from imperceptible minimal loss of substance to severe irreversible damage associated with significant bone pain and restricted mobility.

Osteodystrophia deformans
Bone pain can also be observed in patients with Paget's disease (Osteodystrophia deformans). This pathological change in the bones mainly affects older people and is characterized in the initial stage by inflammatory processes that are associated with increased bone turnover rate and pain in the bones. The bones begin to thicken and deform. Increasingly affected are the pelvis, leg bones and the lumbar spine. Under certain circumstances, the bone changes are also visible from the outside. The heat transfer through the skin is often significantly increased in the affected areas or it can be felt on the skin overheating. Since the changes in the bones sometimes press on the nerve pathways, in the context of a disease of Paget's disease not infrequently, other complaints such as back pain and back pain, sciatic pain and muscle tension (for example, neck tension) and observed.

acromegaly
A rare form of bone disease that may be associated with bone pain is acromegaly, which is perceptible as an enlargement of the body end members and the so-called acres (body parts farthest from the trunk). Affected are especially toes and feet, fingers and hands as well as nose, chin and facial parts such as eyebrow ridges or cheekbones. The Akromelagie is caused by an overproduction of the growth hormone somatotropin, which is why it is from a medical point of view, the so-called endocrine diseases (diseases of the endocrine glands) is assigned. Decisive for the course of the disease is whether it begins before or after puberty. Because the growth joints of the bones are not closed at the onset of the disease, the affected show instead of the conspicuous enlargement of the body end members with corresponding changes in body proportions a general growth in the form of giant growth. If the growth lines are already closed at the onset of the disease, the increased concentration of the growth hormone Somatotropin in the Akromelagie elsewhere leads to uncontrolled growth of articular cartilage and tissue structures. As a result, the conspicuous shift in body proportions of those affected develops. In addition to the bone pain accompanying symptoms such as headaches, fatigue, fatigue, increased sweating and a decrease in sexual excitability are observed as accompanying symptoms due to the disruption of hormone balance. As a result of acromelage, the risk of hypertension, diabetes and cardiovascular diseases increases.

Engelmann syndrome
Another rare cause of bone pain is Engelmann syndrome, which describes uncontrolled thickening of the bones. The resilience of the bone structure goes back significantly. The Engelmann syndrome is an inherited disease that leads to an excess formation of bone tissue in childhood and can cause corresponding bone pain. First, usually usually tubular bones such as tibia, thigh bone, spokes or ulna are affected. In the later course of the disease, the discomfort spreads to other bones and it shows more concomitant impairments of the surrounding muscles. In the late stages, the disease may also affect the skull base and lower jaw, which may narrow the canals of the cranial nerves. If a nerve is pinched here, neurological deficits such as hearing loss, blurred vision and facial paralysis are threatening.

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

An osteosarcoma directly affects the bone and is characterized by uncontrolled cell growth of the bone matrix. The bones are increasingly damaged and the patients suffer from considerable pain. It threatens the formation of metastases in the lungs. Osteosarcomas usually first manifest themselves on the long bones near the joints, although younger people may well be affected. Multiple myelomas are another form of cancer that develops directly in the bone. They are considered to be particularly malignant, affect the bone marrow and lead here to an uncontrolled proliferation of the so-called plasma cells, which in turn are used for the production of antibodies. The plasma cells cause a dissolution of the bone and considerable bone pain. In addition, the excessively produced antibodies not infrequently lead to deposits in the tissue, which in turn can lead to circulatory disorders or impaired kidney function, for example.

Other causes of bone pain

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

hyperparathyroidism
By a regulatory disorder of the parathyroid glands too much parathyroid hormone is formed in a so-called hyperparathyroidism, resulting in an increased degradation of the bone substance. The calcium from the bones is dissolved, causing demineralization and possibly bone pain. At the same time, parathyroid hormone decreases calcium release via the urine, resulting 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 pancreatitis. Typical concomitant symptoms in such cases are massive abdominal pain (acute abdominal pain).

Chronic kidney disease
In chronic kidney disease, bone metabolism is often severely affected, which can lead to bone changes and bone pain. Impairment of vitamin D metabolism, reduced intake of calcium via the intestine, and hyperacidity of the blood cause significant bone loss associated with similar symptoms as osteoporosis. In addition to bone pain, chronic kidney disease can cause various other symptoms such as high blood pressure, damage to the peripheral nervous system, or in the worst case fatal diseases of the heart (coronary heart disease, pericarditis).

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

Opioid withdrawal syndrome
Dependence on opioids (for example heroin) shows signs of withdrawal just a few hours after the last dose. The withdrawal symptoms usually reach their peak after one and a half to three days and can include symptoms such as hot flashes, heavy sweating, palpitations, goose bumps, loss of appetite, fever, increased heartbeat and respiratory rate, diarrhea, nausea and vomiting. Especially in the lower extremities are due to the Opioidentzugsalso to observe muscle pain and bone pain.

Acute leukemia
Another possible cause of bone pain is acute leukemia (blood cancer). In contrast to chronic leukemia, it occurs relatively suddenly, with very different symptoms. General weakness, an increased tendency to bleed, tiny tissue bleeding and increased bruises may be the first indications here. In addition, sufferers increasingly start to sweat at night, show lymph node swelling, and often have enlargement of the liver and spleen. Accompanying bone pain may be added, but these are not an integral part of the disease. Acute leukemia can lead to death of the patient within a relatively short time (a few weeks) if treatment is not taken.

scurvy
A formerly quite common cause of cooking pains, which is hardly found in Europe today, is the vitamin deficiency disease scurvy. In the case of a diet without or with only minimal amounts of vitamin C, the first physical symptoms appear after four months at the latest. The sufferers are more prone to bleeding gums, are constantly tired and exhausted, suffer from dizziness and are struggling with skin problems. High fever, diarrhea, poorly healing wounds, tooth loss and muscle wasting are another feature of vitamin deficiency disease. Bone pain in scurvy is caused by bleeding below 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 by a heart failure in case of persistent vitamin C deficiency.

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 such a disease is extremely low, these triggers should also be considered if no other causes of bone pain can be identified. Typical concomitant symptoms of SAPHO syndrome include severe acne, formation of purulent vesicles on the hands and feet, articular capsule inflammation, osteomyelitis, and abnormal bone augmentation (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, which mainly occur in the connective tissue. Tumor-like tissue changes are formed, which can also affect the skeletal system. Depending on where the histiocytosis manifests, very different symptoms are observed. Since the skeletal system is relatively frequently affected, bone pain is one of the more common complaints of Langerhans cell histiocytosis and Erdheim-Chester disease. An infestation of other organs (for example, lung, liver or spleen) is in the course of both diseases, however, not uncommon, and this can have fatal consequences in the worst case. Also, skin irritation, such as an itchy rash, and fever are increasingly associated with the histiocytosis. Overall, however, the spread of Langerhans cell histiocytosis and Erdheim-Chester disease is fortunately extremely low.

diagnostics

At the beginning of the diagnosis, a detailed medical history should be taken in order to limit the causes of bone pain as far as possible. It was followed by a first physical examination with palpation of the painful body regions and a superficial assessment. Exercise tests can also be offered here. X-rays are a frequently used diagnostic procedure for bone complaints, as here stronger 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. In the vitamin deficiency disease, the bleeding under the periosteum can be clearly seen.

To more accurately determine what kind of bone structure changes are, if necessary, a bone density measurement is made and a bone tissue sample (bone biopsy) taken. A biopsy is also the drug of choice in the diagnosis of tumors. Modern imaging techniques, such as computed tomography (CT) or magnetic resonance imaging (MRI), can also provide further important information for the diagnosis. Substantial information on the assessment of bone pain may also result from the laboratory examination of urine and blood samples of those affected. In this way, for example, both chronic nephropathy, as well as a hyperparathyroidism, osteodystrophia deformans or acute leukemia can be relatively clearly determined.

therapy

The treatment options for bone pain are highly dependent on the triggers of the complaints. While complete healing can be achieved in some diseases that cause bone pain, others are still untreatable. Here, 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 until today no cure, but only a slowing down of the disease process can be achieved. As part of the therapy is usually an adaptation of the diet to ensure the required calcium intake and the exercise of physical activities to stimulate bone formation is recommended. In addition, as vitamin D plays an essential role in bone formation and is formed only when the skin contacts the sunlight, it is recommended that sun rays reach the skin for at least 30 minutes a day. The intake of vitamin D supplements can also be helpful here. In addition, medicines are available to reduce bone resorption or stimulate bone formation, but these are sometimes associated with significant side effects and are therefore not uncontroversial. The possibilities of naturopathic osteoporosis therapy are described below in the section "Naturopathy for bone pain".

Therapy for osteomalacia
Since bone softening is usually due to a lack of calcium or vitamin D, the standard therapy here sees an adaptation of the diet to calcium-containing foods (for example milk, cheese, kale or broccoli), sufficient sun contact and possibly the ingestion of calcium. and vitamin D supplements. If the osteomalacia goes back to a lack of phosphate, a corresponding application of phosphate preparations is provided. Targeted correction of the deficiency that has caused osteomalacia can help to stop the progression of bone softening and thus bone pain in most cases.

Treatment of aseptic bone necrosis
The aseptic bone necrosis and associated bone pain are - depending on the extent and the localization of the complaints - treatable with very different procedures. First, it is important to protect the affected bones or relieve, which is usually done by immobilizing. So-called relief wells are intended for invasive surgery in more severe forms of aseptic bone necrosis. Bone grafting and the use of so-called endoprostheses may also be required for pronounced bone necrosis. In less severe forms and in the early stages of the disease, the hyperbaric oxygen therapy (inhalation of pure oxygen at elevated ambient pressure) is said to have a promising effect.

Treatment in osteodystrophia deformans
For osteodystrophy deformans or Paget's disease, the treatment also focuses on alleviating the symptoms, since healing based on today's medical knowledge is not possible. Painkillers and anti-inflammatory drugs are usually an integral part of orthodox medical therapy. Accompanying the sufferers often physiotherapy is prescribed to maintain mobility as possible and to stabilize the musculoskeletal system. Also drugs that inhibit the degradation of the bone substance (bisphosphonates) are used in the treatment of Paget's disease. As a last option remains an operative correction of the bones or the replacement by a prosthesis.

Acromegaly treatment
Acromegaly is usually due to a tumorous process in the pituitary gland, which is treated with a surgical removal of the tumor. In preparation for the surgical procedure or after an unsuccessful surgical elimination, a drug treatment can be carried out, with the focus in the context of medical follow-up the normalization of hormone release. As a last resort remains a radiation therapy, however, brings with it significant side effects and therefore can only be considered if all other therapeutic approaches were unsuccessful.

Therapy of Engelmann syndrome
The Engelmann syndrome is not curable as a hereditary disease, but the long-term therapy with corticosteroids can bring about a significant relief of the symptoms. Under certain circumstances, however, the growth of those affected by the therapy is significantly impaired.

Treatment for bone metastases and bone cancer
While there are treatment options in the bone cancers, for example in the form of surgical removal, radiation therapy, chemotherapy or stem cell transplantation, which can effect a healing, bone metastases are usually not curable and the therapy aims at a palliative care of the patients. This also applies to the radiation and chemotherapies that may be performed on bone metastases. However, surgical interventions on the affected bones not only offer the possibility of removing the tissue affected by bone metastases in the short term, but in very rare cases a cure has also been achieved with special metastases (of renal cell carcinoma).

Treatment of other causes

Appropriate treatment strategies are used against the various other potential triggers of bone pain. The spectrum ranges from a simple change of diet (for example, in scurvy) on massages for growing pains or a drug-based Opioidentzug to surgical intervention (for example, hyperparathyroidism) and radiotherapy, chemotherapy and stem cell therapy for acute leukemia. If the cause of the bone pain is diagnosed, however, it can generally be stated quite clearly what the treatment options look like and the success they promise.

As far as treatment options for extremely rare cases are concerned, we have little established knowledge of the SAPHO syndrome or Erdheim-Chester disease and often use a combination of physiotherapy, analgesics, immunosuppressants, bisphosphonates, certain antibiotics, steroids and interferon to respond to the symptoms.

Naturopathy with bone pain

Naturopathy has quite promising treatment options against some potential causes of bone pain, but in most cases these are only suitable for concomitant therapy. Also, the natural healing of cancer and hereditary diseases usually little oppose.

In the case of osteoporosis, a fundamental nutrition is attributed in natural medicine or the balance in the acid-base balance, because the acidification of the body is responsible for an increased calcium metabolism in the bones. It should also be achieved with the help of magnetic therapy stimulation of 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 is used against bone loss, the Schüssler salts no. 1 (Calcium Fluoratum), No. 2 (Calcium Phosphoricum) and No. 11 (Silicea) find application. Furthermore, various medicinal plants such as horsetail, comfrey or sea algae are used in the treatment of bone pain. The orthomolecular medicine with high-dose vitamin treatment promises relief especially in the disorders of bone metabolism as a result of deficiency symptoms. The manual treatment methods such as Rolfing or osteopathy may offer a promising concomitant therapy, especially if the musculoskeletal system is impaired by the different bone diseases. Homeopathy uses Arnica to relieve acute bone pain, such as 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 to delay bone growth.

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