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Bone Pain - What Arthritis Patients Should Know

Differentiating Bone Pain and Joint Pain

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Updated April 26, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Bone Pain
Jon Feingersh Collection: The Image Bank

It's not uncommon for people with arthritis to say that they feel achy or that their bones hurt. Are they really experiencing bone pain, or is it joint pain? What's the difference?

Causes of Bone Pain

Generally, bone pain is less common than joint pain or muscle pain. Bone pain can be caused by injury, such as traumatic injury that causes a fracture. Bone pain also can occur with bone cancer, cancer that has metastasized to the bone, osteomyelitis (i.e., infection of the bone), osteoporosis, Paget's disease of bone, leukemia, or disrupted blood supply associated with sickle cell anemia.

Bone pain associated with such conditions can be debilitating. Metabolic bone diseases are tied to increased bone resorption (osteoclasts break down bone and release minerals), a process that can be painful directly or indirectly. Various pathways and mediators contribute to bone pain in such cases. It's complex and not easily understood -- just as the sensation of pain from bone is not perfectly understood. It is thought that bone pain is either due to a direct action on bone nociceptors (sensory receptors which send signals that cause the perception of pain) or as a secondary consequence of something mechanical, for example, a vertebral compression fracture. Yet another example of the complexity of bone pain -- bone loss (as with osteoporosis) is not usually associated with bone pain until a fracture occurs. Vertebral fractures can occur without pain or other symptoms, too.

Distinguishing Between Bone Pain and Joint Pain

Bone pain tends to be localized and is often described as sharp pain, especially when associated with fracture. Even the sensation produced by bone cancer has been described as similar to having breaks in the bone.

Joint pain is typically limited to the affected joint. Joint pain can be sharp and intense when cartilage is completely worn away or eroded and the condition of the joint is described as bone on bone. More often, joint pain is described as being achy. Depending on the specific joint affected, joint pain can worsen with activity, overuse, or weightbearing.

Don't Ignore Bone Pain

It goes without saying that if you experience bone pain or bone tenderness, you should consult your doctor. Along with your medical history and a physical examination, expect your doctor to ask you about the location of the pain, when the bone pain was first noticeable to you, how long the pain has lasted, and if the pain is worsening. You likely will be asked if anything specific makes the bone pain worse or better, or if it is constant. You may discuss other new symptoms, too, if there are any. Blood tests, imaging studies, and other diagnostic tests will be ordered.

While diagnosis can sometimes be difficult, treatment will be initiated as soon as possible with the goal of reducing pain and improving mobility and function. While it may seem counterintuitive, immobilization is generally avoided. Depending on the cause, an analgesic medication, such as acetaminophen, is the usual starting point with progression to nonsteroidal anti-inflammatory drugs (NSAIDs) and narcotic analgesics if needed.

Sources:

Bone Pain or Tenderness. MedlinePlus. 4/14/2013.
http://www.nlm.nih.gov/medlineplus/ency/article/003180.htm

Differential Diagnosis: Bone Pain and Fractures. Osteoporosis in Clinical Practice. Gennari and Gonnelli. 2004.
http://link.springer.com/chapter/10.1007%252F978-0-85729-402-9_11

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