03/11/2020
DJS Research Update re Bone Pain: For patients who begin w bone/osteo issue and develop chronic "bone pain" with increasing disability. What was intended as a reassuring pat on the knee can feel - for days or weeks - like someone smashed your knee with a sledge hammer.
Med literature uses the term "iatrogenic pain" for "pain relating to medical treatment and/or mistreatment." With the current emphasis on bone surgery and joint replacement (vs TrP therapy) to prevent long term bone pain, many develop treatment related bone pain and nerve proliferation. Those "extra nerves" increase pain levels and facilitate CNS sensitization called Fibromyalgia/FM, Chronic Myofascial Pain and Dysfunction/CMPD and Chronic Regional Pain Syndrome/CRPS. [Read "nerve repair after injury" to understand proliferation better.]
FM multiplies pain to insane levels and long term complications caused by provider ignorance of non-pharma treatment causes increasing pain and physical dysfunction. [All tissue including periosteum gets MTrPs and CMPD is self-treatable.] Disabling pain and shock are often introduced by ignorant specialists doing other completely non-related procedures.
When writing a loved one in pain speak, we use this symbol for "gentle hugs." {{{}}} I, of course, put my heart in my hugs = So here's one for you! {{{❤}}} Now, on to that research most docs won't see for 19 more years. [It takes 19 yrs for yr doc to read research. Patients can screen to help your doc help you!]
Research update: Oostinga D, Steverink JG, van Wijck AJM, et al. 2020. An understanding of bone pain: A narrative review. Bone. Feb 13;134:115272. “Skeletal pathologies are often accompanied by bone pain, which has negative effects on the quality of life and functional status of patients. Bone pain can be caused by a wide variety of injuries and diseases including (poorly healed) fractures, bone cancer, osteoarthritis and also iatrogenic by skeletal interventions. Orthopedic interventions are considered to be the most painful surgical procedures overall. Two major groups of medication currently used to attenuate bone pain are NSAIDs and opioids. However, these systemic drugs frequently introduce adverse events, emphasizing the need for alternative therapies that are directed at the pathophysiological mechanisms underlying bone pain. The periosteum, cortical bone and bone marrow are mainly innervated by sensory A-delta fibers and C-fibers. These fibers are mostly present in the periosteum rendering this structure most sensitive to nociceptive stimuli. A-delta fibers and C-fibers can be activated upon mechanical distortion, acidic environment and increased intramedullary pressure. After activation, these fibers can be sensitized by inflammatory mediators, phosphorylation of acid-sensing ion channels and cytokine receptors, or by upregulation of transcription factors. This can result in a change of pain perception such that normally non-noxious stimuli are now perceived as noxious. Pathological conditions in the bone can produce neurotrophic factors that bind to receptors on A-delta fibers and C-fibers. These fibers then start to sprout and increase the innervation density of the bone, making it more sensitive to nociceptive stimuli. In addition, repetitive painful stimuli cause neurochemical and electrophysiological alterations in afferent sensory neurons in the spinal cord, which leads to central sensitization, and can contribute to chronic bone pain. Understanding the pathophysiological mechanisms underlying bone pain in different skeletal injuries and diseases is important for the development of alternative, targeted pain treatments. These pain mechanism-based alternatives have the potential to improve the quality of life of patients suffering from bone pain without introducing undesirable systemic effects.”[Netherlands] [There may be many different causes of bone pain.]
