Article by Dr Manasa S, B.A.M.S

Bone pain is more than just discomfort—it’s a vital signal from your body that something may be wrong. It affects millions of people worldwide, with causes ranging from acute injuries and metabolic disorders to serious conditions like osteoporosis, infections, and malignancies.

Studies indicate that bone pain prevalence varies widely depending on the underlying condition. For instance, osteoporosis alone affects over 200 million people globally, contributing to an increased risk of fractures and chronic pain. Meanwhile, metastatic bone disease accounts for a significant portion of cancer-related pain, impacting nearly 70% of patients with advanced malignancies.

Epidemiologically, bone pain is a widespread health concern, particularly among aging populations, individuals with chronic illnesses, and those recovering from fractures or orthopaedic surgeries. It is also a key symptom in conditions like rheumatoid arthritis, osteomyelitis, Paget’s disease, and vitamin D deficiency, highlighting its diverse aetiology.

From a clinical standpoint, addressing bone pain is critical, as it not only affects mobility and quality of life but also serves as an early indicator of serious underlying diseases. Delayed diagnosis can lead to complications such as fractures, deformities, functional impairment, and systemic health decline. By understanding the causes, recognizing symptoms, and seeking timely medical intervention, individuals can improve their bone health and overall well-being.

In this article, we will explore the causes and diagnosis of bone pain and also the treatment options available for bone pain, which would help in regaining strength, mobility, and a better quality of life. Let us delve into the factors that affect the bones and discover how to keep them strong and resilient.

Common Causes of Bone Pain

Bone pain can arise from various causes, often categorized into traumas, health conditions, benign tumours, and cancers. Below is an overview of the primary causes of bone pain:

Traumas and Injuries

–        Car accidents

–        Sports injuries

–        Falls

–        Bone fractures

Health Conditions that Weaken Bones

–        Osteoporosis

–        Osteoarthritis

–        Avascular necrosis (osteonecrosis)

–        Osteomyelitis

–        Osteomalacia and Vitamin D deficiency

–        Paget’s disease of the bone (osteitis deformans)

–        Osteopenia

–        Rickets

Benign (Noncancerous) Bone Tumours

–        Aneurysmal bone cysts

–        Osteoblastomas

–        Exostoses

–        Osteochondromas

Cancer Types That Cause Bone Pain

–        Bone cancer

–        Osteosarcoma

–        Leukemia

–        Metastatic cancer (cancer that spreads to bones)

Detailed overview of understanding and Managing the Underlying Common Conditions related to bone pain

Bone pain can stem from various causes, ranging from mechanical injuries to chronic conditions and systemic diseases. Below is a professional breakdown of the primary causes, symptoms, diagnostic methods, and treatment options for bone pain, suitable for healthcare providers and general readers.

Osteoporosis

Osteoporosis is a condition where bones become thin and weak, typically associated with aging but can affect younger individuals. Approximately 54 million people in the U.S. are impacted by osteoporosis. Risk factors include:

–        Underlying health conditions

–        Certain medications

–        Genetic predisposition

–        Hormonal changes

–        Lifestyle factors like smoking and diet

Symptoms and Diagnosis:

Bone pain and fractures are common indicators. Bone density scans help diagnose osteoporosis, while X-rays confirm fractures.

Prevention and Treatment:

–        Maintain a healthy weight

–        Engage in weight-bearing exercises like walking

–        Ensure adequate Vitamin D and calcium intake

–        Avoid smoking

Osteoporosis shall be considered as Asthi Kshaya or Asthigata Vata and treated on the similar lines.

Bone Bruises

A bone bruise occurs when a bone sustains trauma, often due to impact or falls, and is frequently associated with other injuries such as ACL tears.

Symptoms:

–        Localized bone pain with tenderness

–        Swelling and discoloration

Diagnosis and Treatment – Diagnosed via physical examination and imaging tests.

Treatment includes:

–        Rest: Essential for healing

–        Ice: Reduces swelling and pain

–        Support: Braces for stability near joints

Prevention:

Wear protective gear during activities, such as shin guards for sports and helmets for cycling.

Bone Bruises can be considered as Agantuja or Abhighataja Asthi Shula / Ruja. Treatment for trauma or sustained injury on the lines of Bhagna Chikitsa and treatment for aggravated Vata are the key principles of dealing with these conditions.

Fractures

Fractures result from trauma, repetitive stress, or weakened bones due to conditions like osteoporosis.

Symptoms:

–        Sharp pain exacerbated by movement

–        Swelling, bruising, and deformity

Diagnosis and Treatment:

Imaging confirms the fracture, with treatment varying from splints for minor fractures to surgery for severe ones. Rehabilitation often includes physical therapy to restore strength and mobility.

Bhagna Chiktisa principles and the other Ayurveda interventions mentioned above in the context of Bone Bruises shall be adopted in these conditions.

Infections (Osteomyelitis)

Osteomyelitis is a bone infection caused by bacteria or, less commonly, non-bacterial factors.

Symptoms include dull bone pain, swelling, warmth, redness, and fever.

Diagnosis:

Blood tests and imaging are critical for diagnosis.

Treatment:

Intravenous antibiotics or surgical removal of infected tissue may be necessary.

Osteomyelitis treatment in Ayurveda includes integrating treatment of Vidradhi / Asthi Vidradhi, Krimi Chikitsa and Asthigata Vata / Asthigata Pitta and Vatarakta Chikitsa. Visha Chiktsa too should be considered.

Osteonecrosis

Osteonecrosis occurs when bone blood supply is compromised, leading to bone cell death.

Symptoms:

Pain and limited mobility, such as limping with hip involvement.

Risk Factors:

–        Prolonged corticosteroid use

–        Excessive alcohol consumption

–        Underlying medical conditions (e.g., lupus)

Treatment:

Anti-inflammatory medications or surgical interventions may be required.

Ayurveda treatment principles will be the same as those mentioned above, in the context of Osteomyelitis.

Osteomalacia

This condition involves bone softening due to reduced mineralization, commonly caused by Vitamin D deficiency.

Symptoms:

–        Generalized bone pain and tenderness

–        Muscle weakness and difficulty walking

Treatment:

Vitamin D supplementation can significantly alleviate symptoms within weeks.

Diagnosis and treatment from Ayurveda Perspective will be on the lines of Asthigata and Asthi Avruta Vata.

Paget’s Disease

Paget’s disease involves abnormal bone remodelling, leading to brittle or misshapen bones.

Symptoms:

Bone pain – often in the spine, pelvis, femur, or skull.

Diagnosis and Treatment:

Blood tests and imaging confirm the condition. Bisphosphonates and, in some cases, surgery are effective treatments.

Paget’s Disease can be considered as ‘Adhyasthi’ mentioned in the context of Asthi Vriddhi Lakshanas. Here, the agni related to Asthi dhatu should be addressed.

Vaso-Occlusive Crisis (VOC) in Sickle Cell Anemia

VOC occurs when sickle-shaped red blood cells block blood flow to bones.

Symptoms:

Severe bone pain, especially in the arms, legs, and back.

Management:

Pain relief, infection control, and medications like hydroxyurea are essential.

VOC shall be treated on the lines of Sama Rakta or Sama Asthi condition or on the lines of treating Raktavaha Sroto Dushti or Asthivaha Sroto Dushti. Pandu Roga Chikitsa and Rakta Prasadana too should be considered. Agni dushti and Ama should be addressed promptly.

Bone Cancer

Primary bone cancers (osteosarcoma, Ewing’s sarcoma, chondrosarcoma) and metastatic bone cancers cause persistent bone pain, swelling, and systemic symptoms.

Diagnosis and Treatment:

Biopsies, imaging, and blood tests confirm the diagnosis. Treatment includes chemotherapy, radiation, and surgery.

Leukaemia

Leukemia affects bone marrow, leading to overcrowding of cancerous cells and bone pain.

Symptoms:

Bone pain, particularly in the long bones of the arms and legs.

Diagnosis and Treatment:

Blood tests, bone marrow aspiration, and biopsies are diagnostic. Treatment typically involves chemotherapy and targeted therapies.

Bone Cancer and Leukamia shall be treated on the lines of treating Raka Arbuda or Rajayakshma and aggravated Vata should be addressed. Agni, Ama, Dhatu Samya and Ojas should be looked into for comprehensively addressing these dreadful treatments. Visha Chikitsa too comes in handy.

By recognizing these conditions and seeking appropriate medical care, bone pain can often be effectively managed and underlying issues addressed.

Diagnosing Bone Pain: Key Tests and Procedures

To identify the cause of bone pain, healthcare providers rely on a variety of diagnostic tools and imaging tests:

–         X-ray: Provides a clear view of bone structure to detect fractures, abnormalities, or damage.

–         MRI (Magnetic Resonance Imaging): Offers detailed images of bones and surrounding soft tissues, helping to diagnose conditions like infections, tumours, or osteonecrosis.

–         CT scan (Computed Tomography): Produces cross-sectional images for a comprehensive evaluation of complex bone conditions or injuries.

–         Ultrasound: Useful for assessing soft tissue and bone interfaces, especially in cases involving joints.

Additionally, a bone density test (DEXA or DXA scan) may be performed to measure bone strength and assess for conditions such as osteoporosis.

Purpose of Bone Density Test:

–         Evaluates bone mineral density (BMD) to identify thinning or brittle bones.

–         Essential for detecting osteoporosis before fractures occur.

These diagnostic methods enable early detection and effective management of underlying conditions contributing to bone pain.

Understanding the Treatment and Prevention of Bone Pain

Bone pain can be distressing and significantly affect quality of life. Effective treatment begins with identifying the underlying cause, which could range from injury to infections or systemic conditions. Once the cause is determined, targeted interventions can alleviate symptoms and address the root problem.

Treatment Approaches for Bone Pain

1. Rest and Pain Management

–        Resting the affected area minimizes strain and promotes healing.

–        Over-the-counter (OTC) medications like ibuprofen (Advil) or acetaminophen (Tylenol) are commonly used for mild pain.

–        For severe pain, stronger prescription medications such as morphine or Paracetamol may be recommended.

2. Antibiotics for Infections – When bone infections (osteomyelitis) are suspected, powerful antibiotics like ciprofloxacin, clindamycin, or vancomycin are prescribed. Completing the full antibiotic course is crucial, even if symptoms improve early.
3. Corticosteroids – These are often prescribed to reduce inflammation associated with autoimmune conditions or injury.
4. Nutritional Supplements – For conditions like osteoporosis, supplements such as calcium and vitamin D help restore mineral deficiencies. These are available in liquid, pill, or chewable forms.
5. Cancer-Related Bone Pain

Treating bone pain due to cancer involves addressing the cancer itself. Common interventions include:

–        Radiation therapy

–        Chemotherapy (though it may initially worsen pain)

–        Bisphosphonates to prevent bone damage in metastatic cancer.

In severe cases, opiate pain relievers may be used.

6. Surgical Interventions

Surgery may be required for:

–        Removing infected or dead bone tissue.

–        Resetting fractures.

–        Tumour removal.

In advanced cases, reconstructive surgery can replace damaged joints.

Preventing Bone Pain: A Holistic Approach

Maintaining bone health is key to preventing bone pain. Consider the following strategies:

Healthy Lifestyle Choices:

–        Incorporate weight-bearing exercises to strengthen bones.

–        Ensure adequate intake of calcium and vitamin D through diet or supplements.

–        Avoid smoking and limit alcohol consumption.

Injury Prevention:

–        Keep living spaces safe by reducing clutter, securing rugs, and ensuring good lighting.

–        Use appropriate protective gear during sports or high-risk activities.

By adopting these practices, both the risk of bone pain and the likelihood of fractures can be minimized.

Bone pain is manageable with timely and appropriate care. Whether addressing an infection, a nutritional deficiency, or a more complex condition like cancer, the focus should always be on a comprehensive treatment plan. Maintaining strong bones through a healthy lifestyle is a proactive step everyone can take.

When to Call a Healthcare Provider?

Bone pain should not be ignored, especially if it is:

–         Severe

–         Persistent

–         Worsening over time

Seek medical attention urgently if your bone pain is accompanied by any of the following symptoms:

–         Swelling

–         Redness

–         Warmth

–         Fever

–         Unintentional weight loss

–         Palpable mass or lump

These signs may indicate an underlying condition requiring prompt evaluation and care.

Key Takeaways on Bone Pain

Bone pain is not just a minor discomfort—it is a crucial indicator of underlying health issues that should not be ignored. Whether caused by injury, osteoporosis, infections, or serious conditions like cancer, timely diagnosis and appropriate treatment are essential for preventing complications. Maintaining bone health through a balanced diet rich in calcium and vitamin D, regular weight-bearing exercises, and routine medical checkups can help reduce the risk of bone-related disorders. If you experience persistent or worsening bone pain, seeking medical attention promptly can improve outcomes and enhance your overall quality of life. Prioritizing bone health today ensures mobility, strength, and resilience for the future.

Bone Pain – Ayurveda Understanding

Pain anywhere in the body is due to aggravated vata. So, bone pain is also mainly caused due to the affliction of bone by aggravated vata. Asthi i.e. bone is also one of the important seats of Vata. So, vata aggravation would affect bones also.

Common Conditions wherein the aggravated Vata afflicts the bones are –

–         Asthigata Vata

–         Sandhigata Vata

–         Vatarakta

–         Amavata

–         Mamsa-Meda-Majjagata Vata

The bone pain can either be primary as said in the above said conditions. Bone pain can also be secondary to other systemic diseases like Jwara, Visarpa, Phiranga, Kanda Bhagna, Grahani, Arshas, Atisara and Twakgata Vata. In these conditions, the treatment principles would be to treat the main disease which causes bone pain.

In primary bone pain conditions, medicines, therapies and lifestyle changes to relieve pain, to combat the dosha, mainly vata and to improve the health, balance and immunity of bone tissue will be the key principles.

External therapies like Abhyanga, Swedana, Taila Dhara, Ksheera Dhara, Lepa and Upanaha will be helpful.

Vasti will be the main therapy which will be highly effective to cure the bone pain be it acute or chronic, moderate or severe in nature.

Virechana in case of bone pain caused by aggravated pitta and Vamana and Virechana in cases of bone pain caused by aggravated kapha are the main therapies.

Prevention includes identifying the causes and triggers of the pain and keeping them away and also promptly treating the disease which causes pain in the bones.

Ama, status of Agni, afflictions of Asthivaha Srotas, involvement of Marmas related to bones, involvement of secondary doshas or associated doshas and Agantu factors like trauma etc should be considered while analysing the bone pain from Ayurveda perspective.

Related Reading – ‘Bone Pain – Ayurveda Understanding’