Ostealgie

from Wikipedia, the free encyclopedia

Ostealgie (from ancient Greek ὀστέον ostéon , German 'bones' and ancient Greek ἄλγος algos , German 'pain' ) are pain that those affected feel in the bones.

Bone pain can easily be confused with tension and improper strain on the muscles without an actual bone disease being present. Conversely, it can also happen that bone pain is not recognized. Actual bone pain can be divided into generalized and localized bone pain. The former are due to metabolic or metastatic diseases. The pain is often difficult to localize in those affected.

Diseases that lead to bone pain

Diseases that lead to bone pain are represented in many ways. A list of the possible diseases follows:

Bone pain and cancer

Bone pain is a symptom that is common in cancer and is one of the most common pains with a nociceptive or neuropathic character. Metastases that affect the skeletal system are the most common malignancy of the bone and occur in up to 70% of all patients with a tumor, depending on the primary tumor. More than half of patients with bone metastases report bone pain after the metastases are identified. As the disease progresses, bone pain is usually a constant symptom that increases in intensity.

The pain emanating from the bone can have various causes. In 85% of the cases, the pain is caused by the tumor. 17% of those affected feel pain triggered by the therapy. In 9% of the cases, the pain is associated with the tumor, so it is not caused directly by the tumor or metastases, but rather a general weakening of the body. 70–80% of the various types of pain are not single, but two or more of these pains are present.

It is also possible that the pain radiates from affected parts of the body to other regions. For example, metastases in the cervical and upper thoracic spine can cause pain not only locally, but also in the neck and shoulders.

Bone Pain and Cancer in Children and Adolescents

Bone pain is the most important key and individual symptom in malignant diseases in children and adolescents. In childhood, diffuse bone pain occurs in leukemia , neuroblastoma, and pain that is localized in bone tumors. Especially with neuroblastoma, the general symptom of bone pain is common and can lead to misdiagnoses such as rheumatic diseases or osteomyelitis being made.

Bone pain and osteoporosis

Osteoporosis is one of the most important common diseases. In Germany, around 6.3 million people suffer from it (as of 2013), especially older women. The bones of those affected continue to break down, which is why the bones become more and more unstable and fragile. This can lead to bone pain, especially in the back area.

Bone Pain in Children and Adolescents

In children and adolescents, bone pain is often a key symptom and the most common single symptom as an indication of malignant diseases.

Diffuse bone pain is understood to be a wandering symptom. Leukemia in particular triggers this pain. The patient has complaints mainly in the long bones, such as arms and legs. These migrate within the bone in the course of the disease.

Localized bone pain refers to bone pain that affects a bone or a section of bone. Patients having metaphyseal localized osteosarcoma .

Ewing's sarcoma , which is localized in the diaphysis , is a bone tumor that occurs particularly in childhood.

Characteristic are small round blue cells and a tumor-specific chromosomal translocation with fusion of the EWS gene with another gene. Over 80% of those affected usually develop a sarcoma before the age of 20. This originates from the connective tissue bone marrow framework and forms on a section of the bone, the diaphysis.

But bone pain can also have other reasons. The reason could be growing pains, which often occur in girls between the ages of four and six.

Under growing pains is meant mostly nocturnal pain occurring in the lower extremities, with the exception of the joints. The majority of the pain occurs on both sides of the body and lasts for a short period of time, but does not increase in intensity. The gait pattern is inconspicuous, sporting activities are unimpaired.

Massage or muscle stretching can provide relief.

Bone pain by age and gender

Bone pain is common in all age groups. The German Pain Society eV (V) initiated in 1998 the documentation system "QUAST", an evaluation-oriented EDP system for documentation and quality assurance in pain therapy, the basis for an anonymized database. Here you can find data on thousands of patients who were ready to be questioned and examined.

The aim of the survey was not just how many people suffer from chronic pain. The question of therapy and how quickly patients are ready to see a doctor for help was also important. A total of 10,054 patients of different ages and genders were included in the database.

The result of the investigation was that mostly patients aged 53 and over complained of pain. This value has a deviation of ± 15.3 years.

60% of the respondents were patients who complained about bones, limbs, muscles or headaches. 63% of the respondents were married and 34% were housewives.

Criteria such as school leaving certificate, occupation or marital status also play a role. Here they found out whether pain was caused by physical stress or biological factors.

The result was that not only physical strain can lead to various pains. The mental state also plays a role. If someone is physically and emotionally balanced, this can show up in different parts of the body.

diagnosis

In the case of the unspecific symptom of bone pain, doctors are confronted with a differential diagnostic problem due to the multitude of possible causes. A medical history that is as accurate as possible is crucial for a correct diagnosis . Diagnosing infants and children is particularly difficult, as they can have difficulty describing the pain precisely.

When diagnosing or taking a pain history, the attending physician inquires about the duration, intensity, character, location, radiation and temporal pattern. In many cases, bone pain is rather diffuse and difficult to assign to a specific location. If the pain is locally attributable to a location, then this can also typically be recognized by an X-ray image . Types of pain can include dull, persistent pain, movement-related pain that is more likely due to inflammation, and referring neurogenic pain.

Documentation of the pain on the part of the patient can be helpful for a correct diagnosis.

The combination of different imaging procedures is often necessary to clarify bone pain. X-rays such as projection radiography are suitable for the immediate clarification of bone pain. The classic screening examination is skeletal scintigraphy. (Low-dose) computed tomography , whole-body MRI or PET-CT are also used for diagnosis.

Therapy and reduction of bone pain

Since the diseases that can lead to bone pain are diverse, there are also various therapeutic approaches. The WHO 3-step model serves as a guide for the responsible doctor.

In the first stage, a non-opioid analgesic is administered alone or with an adjuvant substance . In the second stage, a weak opioid is administered alone or in combination with a non-opioid analgesic and / or an adjuvant substance. In the third stage, a highly effective opioid alone or in combination with a non-opioid analgesic and / or an adjuvant substance. (Kretschmer (2018))

A causal therapy can usually not be avoided, e.g. B. this is carried out through vitamin D therapy.

Additional symptomatic pain therapy is often necessary. For mild to moderate pain, NSAIDs , ibuprofen , paracetamol, diclofenac and metamizole can be used .

Pathogenesis of bone pain

How bone pain develops is a complex process that is not yet fully understood. "In addition to mechanical factors such as increased pressure in the medullary canals, bending of the bone, stretching of the periosteum / endosteum and destruction of bone tissue, humoral, inflammatory and neural factors play a role."

In cancer, cancer cells grow into healthy tissue and destroy it. These can go unnoticed for a long time until nerves are affected and wounds develop. Bone tumors or metastases build pressure on the bony membranes. Tumor growth can also cause smaller or larger fractures that cause pain.

Individual evidence

  1. ^ Burg, H., Moser, A .: Medical terms. Handbook of traffic accident reconstruction . Springer Verlag, Heidelberg.
  2. ↑ a b c d e f Bartl, Reiner / von Tresckow, Emmo / Bartl, Christoph: Bisphosphonat-Manual. Effects, indications strategies . Springer-Verlag, Heidelberg 2006, p. 201 .
  3. ^ S. Grond, D. Zech, G. Horrichs-Haermeyeur and KA Lehmann: Pain Therapy in the Final Phase of Malignant Diseases . Originals, The Pain, Concepts, Clinic and Research, p. 1-7 .
  4. ↑ Walter Heindel, Raphael Gübitz, Volker Vieth, Matthias Weckesser, Otmar Schober, Michael Shepherd: Diagnostic imaging of bone metastases . Ed .: Deutsches Ärzteblatt. No. 44 , p. 741-747 .
  5. ↑ How pain arises | DKG. Retrieved July 28, 2020 .
  6. ↑ Bone Metastases: Symptoms and Treatment: Mannheim University Hospital. Retrieved July 28, 2020 .
  7. ↑ a b c M. Nathrath, I. Teichert von Lüttichau: Oncological causes of bone pain. In: Monthly Pediatric Medicine, Volume 157, pp. 655-660, 2009, doi: 10.1007 / s00112-009-1962-5
  8. ↑ Richard Eyermann: Oncological emergencies in children: selected key symptoms and immediate measures. tape 4 , 2009, p. 21-24 .
  9. ↑ Sybille Schie: Telomerase activity in neuroblastoma: prognostic significance depending on MYCN amplification, stage, age at diagnosis, histology and gender . Ed .: Phillips University of Marburg. Marburg 2008.
  10. ^ Peyman Hadji, Silvia Klein, Holger Gothe, Bertram Häussler, Thomas Kless: The Epidemiology of Osteoporosis . In: Deutsches Aerzteblatt Online . January 25, 2013, ISSN  1866-0452 , doi : 10.3238 / arztebl.2013.0052 , PMID 23413388 , PMC 3570954 (free full text) - ( aerzteblatt.de [accessed on July 29, 2020]).
  11. ↑ Prof. Dr. med. JD Rings: Osteoporosis and Pain . Ed .: Federal Self-Help Association for Osteoporosis eV Berlin, Boston 2013 ( osteoporose-deutschland.de [PDF; accessed on July 29, 2020]).
  12. ^ A b A. Rack, I. Schmid & A. Jansson: Bone pain in childhood and adolescence. In: Monthly Pediatric Medicine , Volume. 159, pp. 1247-1256, 2011, doi: 10.1007 / s00112-011-2475-6
  13. ↑ Maria Yiallouros, Dr. med. habil. Gesche Tallen: Ewing's sarcoma (brief information). Retrieved August 1, 2020 .
  14. ↑ C. Eggers: Schizophrenia of childhood and adolescence. 2011, Berlin: Medical Scientific Publishing Company. doi: 10.32745 / 9783954661732
  15. ↑ UpToDate® In: Emergency Medicine News : Volume 39, No. 10, S. & nbsP, 34, October 2017, doi: 10.1097 / 01.EEM.0000526111.87061.c1
  16. ↑ C. Frettlöh, C. Maier, H. Gockel et al .: Patient collective of German pain therapy institutions. In: Pain , Volume 23, No. 6, p. 576, 2009, doi: 10.1007 / s00482-009-0836-z
  17. ↑ Jansson, D. Reinhardt: Bone Pain . Springer Verlag, Heidelberg, p. 645-646 .
  18. ↑ Bone Metastases: Symptoms and Diagnostics. Retrieved July 28, 2020 .
  19. ↑ Walter Heindel, Raphael Gübitz, Volker Vieth, Matthias Weckesser, Otmar Schober, Michael Shepherd: Diagnostic imaging of bone metastases . Ed .: Deutsches Ärzteblatt. No. 44 , p. 741-747 .
  20. ↑ Volume 4: Pain Therapy . Georg Thieme Verlag, Stuttgart 2002, ISBN 978-3-13-114881-0 , doi : 10.1055 / b-001-3178 ( thieme-connect.de [accessed on July 29, 2020]).
  21. ↑ Yellow list online: WHO step-by-step plan | Yellow list. Retrieved July 29, 2020 .
  22. ^ DocCheck Medical Services GmbH: Pain. Retrieved July 29, 2020 .
  23. ↑ Bone Metastases: Symptoms and Diagnostics. Retrieved July 28, 2020 .