Spine-Pain

from The National Osteonecrosis Foundation and
The Center for Osteonecrosis Research and Education website

Osteonecrosis means death of bone which can occur from the loss of the blood supply or by some other means. It has been known by a number of other names including ischemic necrosis of bone, aseptic necrosis or avascular necrosis (AVN). AVN has been quite popular in its use because it is shorter to say and write. More recently the term ON (osteonecrosis) has been adopted.

Unfortunately many patients with ON have had the disease for quite some time before symptoms are present. The initial symptoms are usually felt during activity and include pain or aching in the affected joint. Symptoms usually begin slowly and may initially be sporadic. Sometimes, the pain may begin quite suddenly. As the disease progresses, the pain increases and is associated with stiffness and loss of motion of the involved joint. Limping becomes common. The hip is the most common joint affected, and the pain is usually felt in the groin.

There are no established pharmaceuticals (drugs) for the prevention or treatment of osteonecrosis. In order to treat the disease, we must first understand how the disease develops. In spite of considerable effort by researchers, we still do not know for sure what causes some forms of osteonecrosis (that is, the forms that are not a result of a fracture or radiation).

Bisphosphonates

Bisphosphonates are a class of drugs that have been used to treat osteoporosis – a disease that is characterized by a low bone mass. Recently, in an effort to reduce bone loss, one bisphosphonate - alendronate has been evaluated in 60 patients diagnosed with osteonecrosis of the hip10. All patients had symptomatic improvement at one year. Although the follow-up time ranged from three months to five years, only six patients (ten hips) progressed to the point of needing surgery. It is important to note that these patients were also instructed to avoid bearing weight on their affected hip. Recently, concern has been raised relating to a possible association between bisphosphonate therapy and an increased incidence of osteonecrosis of the jaw11,12. Further study is needed to clarify this possible complication.

http://www.nonf.org/nofbrochure/nonf-brochure.htm

from the American Dental Association website.

Symptoms include, but are not limited to:
•pain, swelling, or infection of the gums or jaw
•gums that are not healing
•loose teeth
•numbness or a feeling of heaviness in the jaw
•drainage
•exposed bone

Most cases of osteonecrosis of the jaw associated with bisphosphonates have been diagnosed after dental procedures such as tooth extraction; however the condition can also occur spontaneously. Also, invasive dental procedures, such as extractions or other surgery that affects the bone can worsen this condition.

Because osteonecrosis of the jaw is rare, researchers can not yet predict who, among users, will develop it.

If you receive intravenous bisphosphonates (or received them in the past year) and experience any of these or other dental symptoms, tell your oncologist and your dentist immediately.

More rarely, osteonecrosis of the jawbone has occurred in patients taking oral bisphosphonates.

Because osteonecrosis of the jaw is rare, researchers can not yet predict who, among users, will develop it. To diagnose osteonecrosis of the jaw, doctors may use x-rays or test for infection (taking microbial cultures).

The consensus is that good oral hygiene along with regular dental care is the best way to lower your risk of developing osteonecrosis.

http://www.ada.org/public/topics/osteonecrosis.asp

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The concern, does the taking of oral bisphosphonates to treat osteoporosis outweigh the risk for osteonecrosis of the jaw? Given that it is apparently rare.

Complex-regional pain syndromes (CRPS), formerly known as Sudeck’s dystrophy and causalgia, belong to the neuropathic pain syndromes. CRPS may develop following fractures, limb trauma or lesions of the peripheral or central (CNS) nervous system. Occasionally, CRPS may also develop spontaneously. The clinical picture comprises a characteristic clinical triade of symptoms including autonomic (disturbances of skin temperature, colour, presence of sweating abnormalities), sensory (pain and hyperalgesia) and motor (paresis, tremor, dystonia) disturbances. Diagnosis is mainly based on clinical signs. However, additional laboratory, neurophysiological and radiological examinations may help to corroborate correct diagnosis. Several pathophysiological concepts have been proposed to explain the complex symptoms of CRPS: 1, facilitated neurogenic inflammation; 2, pathological sympatho-afferent coupling; 3, neuroplastic changes within the CNS. Furthermore, there is accumulating evidence that genetic factors may predispose for CRPS. Therapy is based on a multidisciplinary approach. Non-pharmacological approaches include physiotherapy and occupational therapy. Pharmacotherapy is based on individual symptoms and includes steroids, free radical scavengers, treatment of neuropathic pain, and finally agents interfering with bone metabolism (calcitonin, biphosphonates). Sympathetic blocks are useful for the treatment of sympathetically maintained pain. Invasive therapeutic concepts include implantation of spinal cord stimulators. This review covers new aspects of pathophysiology and therapy of CRPS.

PMID: 17443440 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/sites/entrez

The influence of alendronate treatment and bone graft volume on posterior lateral spine fusion in a porcine model.

Conclusions: Alendronate treatment in this study decreased fusion mass remodeling without inhibiting fusion rate. Increased amounts of autologous bone graft could improve the fusion rate in this experimental spine fusion study.

http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&list_uids=15897823&cmd=Retrieve&indexed=google

The Truth About Painkillers 7 myths about the risks and dangers of opioid analgesics

Myth No. 1: Toughing it out is always better than relying on painkillers.

http://health.msn.com/health-topics/pain-management/articlepage.aspx?cp-documentid=100195150&GT1=31035