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bone pain

Pain originating from bone. Also see arthralgia. Etiology: 1) fracture or trauma (focal) 2) infection, osteomyelitis 3) osteoid osteoma (focal) 4) malignancy (primary or metastatic) 5) leukemia 6) Paget's disease (focal or diffuse) 7) osteomalacia (diffuse, vitamin D deficiency) [2] 8) osteoporosis (diffuse) 9) ischemia (sickle cell anemia) 10) metabolic bone disease (diffuse) 11) overuse Management: - NSAIDs [3,6] - glucocorticoids [6] - dexamethasone (up to 24 mg/day in divided doses; 4 mg BID [5]) - useful in patients with renal failure - lack of data of efficacy of epidural glucocorticoids for metastatic bone pain [5] - bisphosphates [6] - pamidronate - zoledronate [6] - literature inconsistent on acute analgesic efficacy of bisphosphonates for bone pain [5] - opiates - calcitonin of no benefit [5]

Related

arthralgia myalgia (muscle pain)

General

musculoskeletal pain

References

  1. Ferri's Clinical Advisor, Instant Diagnosis and Treatment, Ferri FF (ed), Mosby, Philadelphia, 2003, pg 950
  2. Prescriber's Letter 11(2):11 2004 Detail-Document#: 200211 (subscription needed) http://www.prescribersletter.com
  3. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
  4. Choy E, Attar EC, Oh KS, Huang AJ, Kerr DA. Case 33-2014 - A 60-Year-Old Man with Bone Pain. N Engl J Med 2014; 371:1630-1640. October 23, 2014 PMID: 25337753 http://www.nejm.org/doi/full/10.1056/NEJMcpc1310000
  5. NEJM Knowledge+ Question of the Week. Sept 10, 2019 https://knowledgeplus.nejm.org/question-of-week/1783/ - Chow E, Meyer RM, Ding K et al Dexamethasone in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a double-blind, randomised placebo-controlled, phase 3 trial. Lancet Oncol. 2015 Nov;16(15):1463-1472. Epub 2015 Oct 18. PMID: 26489389 - von Moos R, Strasser F, Gillessen S, Zaugg K. Metastatic bone pain: treatment options with an emphasis on bisphosphonates. Support18682990
  6. Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  7. Bone pain or tenderness Medline Plus http://www.nlm.nih.gov/medlineplus/ency/article/003180.htm