Bone Pain In Children Research Articles

Do Bisphosphonates Alleviate Pain in Children? A Systematic Review.

The goal of this systematic review is to analyze the effectiveness of bisphosphonates (BPs) to treat bone pain in children and adolescents who have diseases with skeletal involvement. We included 24 studies (2 randomized controlled trials, 3 non-randomized controlled trials, 10 non-randomized open-label uncontrolled studies, 8 retrospective studies, and 1 study with design not specified). The majority of included studies assessed pain from a unidimensional approach, with pain intensity the most frequently evaluated dimension. Only 38% of studies used validated tools; visual analogue scale was the most frequently employed. BPs were used to alleviate bone pain in a wide variety of pediatrics conditions such as osteogenesis imperfecta, secondary osteoporosis, osteonecrosis related to chemotherapy, chronic non-bacterial osteitis, idiopathic juvenile osteoporosis, unresectable benign bone tumor, and cancer-related pain. Twenty of the 24 studies reported a positive effect of BPs for alleviating pain in different pathologies, but 58% of the studies were categorized as having high risk of bias. Intravenous BPs are helpful in alleviating bone pain in children and adolescents. It is advised that our results be interpreted with caution due to the heterogeneity of the doses used, duration of treatments, and types of pathologies included. In addition, this review shows the paucity of high-quality evidence in the available literature and further research is needed. Before the completion of this review, the protocol was registered to PROSPERO (International prospective register of systematic reviews), PROSPERO 2020 ID # CRD42020158316. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020158316.

Chronic Recurrent Multifocal Osteomyelitis: A Case Report

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare migratory skeletal disorder with non-infectious inflammatory etiology which usually causes bone pain in children and adolescents. Intermittent periods of exacerbation and remission are usually noted during the course of the disease. It is a multifocal bone disease usually involving the metaphyses of long bones. The clinical and Paraclinical findings are non-specific, and indeed CRMO is a diagnosis of exclusion based on multiple criteria. Case Presentation: We present a 6-year-old boy with multiple periods of fever, systemic inflammation and bone pain since he was 2 years old, hospitalized multiple times, received antibiotics and finally diagnosed as a CRMO case. Conclusions: CRMO should be diagnosed according to a variety of clinical and paraclinical findings. In children and adolescents with multiple bone lesions and lytic lesion, one of the differential diagnoses that should be considered is CRMO.

Sublingual ketorolac versus sublingual tramadol for moderate to severe post-traumatic bone pain in children: a double-blind, randomised, controlled trial

ObjectivesTo assess the effectiveness of sublingual ketorolac versus sublingual tramadol in reducing the pain associated with fracture or dislocation of extremities in children.Patients and methodsA double-blind, randomised, controlled, non-inferiority trial...

Skeletal Scintigraphy With 18F-NaF PET for the Evaluation of Bone Pain in Children

Although not commonly used in current clinical practice, the PET agent (18)F-NaF provides an excellent alternative to the standard tracers used for radionuclide bone scintigraphy. This article illustrates the use and appearance of (18)F-NaF PET and shows examples of its utility in the assessment of bone pain in children. Skeletal imaging with (18)F-NaF harnesses both the superior imaging characteristics of PET and the improved biodistribution of the fluoride tracer in comparison with standard nuclear techniques, resulting in excellent-quality images that can effectively be used to investigate the cause of bone pain in children.

The child with bone pain: malignancies and mimickers

Bone pain in children is common. The cause may be as benign as growing pains or as life-threatening as a malignancy. When a cause cannot be established by laboratory tests, physical examination or patient history, imaging of the affected body part is often obtained. Distinguishing benign from malignant processes involving the bones of children, based on imaging findings, can be challenging. The most common benign conditions that mimic pediatric bone tumors on imaging are Langerhan's cell histiocytosis and osteomyelitis. In this review, the current literature regarding the pathology and imaging of these conditions is reviewed. Benign conditions are compared with the most common pediatric bone tumors, Ewing sarcoma and osteosarcoma, with an emphasis on clinical and imaging features that may aid in diagnosis.

Hypophosphatasia may lead to bone fragility: don’t miss it

Hypophosphatasia is an inheritable disorder characterised by defective bone mineralisation due to the impaired activity of tissue-non-specific alkaline phosphatase (AP). Clinical presentation ranges from stillbirth without mineralised bone to pathological fractures in late adulthood. During childhood, the main manifestations include rickets, growth delay and dental problems. Fractures and bone pain usually characterise the adult form. A 9-year-old girl was referred for repetitive fractures after minimal trauma. She had normal growth, normal sclerae, no rickets and minimal dental abnormalities. Her sister had also presented fractures. The proband, her sister and mother had low total and bone-specific AP levels and E435K mutation in exon 12 of the liver/bone/kidney AP gene. Low AP levels must lead to genetic analysis. Bone fragility and repetitive fractures may be symptoms of hypophosphatasia in childhood, which must not be neglected. Associated factors such as vitamin D or calcium deficiency must be prevented. In conclusion, hypophosphatasia must not be forgotten as an aetiological factor of repetitive fractures or bone pain in children and AP activity should be checked accurately.

Orthopedic considerations in Gaucher disease since the advent of enzyme replacement therapy

Gaucher disease, the most prevalent lysosomal storage disorder, is characterized by hepatosplenomegaly, hypersplenism, and rarely, neurological involvement. The most variable symptoms relate to skeletal disease, and both onset and progression are difficult to predict on the basis of genotype. This review describes findings from a large referral clinic (> 500 patients) and from the literature in the decade since the advent of specific enzyme replacement therapy. Such therapy is effective in reducing visceral and hematological involvement, but its greatest advantage as regards the skeleton is prevention of irreversible damage. Avascular necrosis of the joints-particularly the hips but also the knees and shoulders-and pathological fractures of the long bones including the ribs, as well as episodic "crises' of bone pain in children and young adults, are common manifestations. Various imaging modalities should be performed at baseline for life-long monitoring, and then as required because of specific complaints. Surgical interventions such as joint arthroplasties are important adjuvant treatments in this population; presurgical hematological profiling plus antibiotic cover and postoperative pain control are equally critical. Opportunities for orthopedic consultations with senior surgeons are not abused by our patients. These reflect disease-related morbidity, with greater numbers of requests being made by patients requiring enzyme therapy, who by definition have more severe disease characteristics.

Differentiation between bone infarction and acute osteomyelitis in children with sickle-cell disease with use of sequential radionuclide bone-marrow and bone scans.

The differentiation of bone infarction from acute osteomyelitis in patients with sickle-cell disease is challenging, as the clinical presentations of the two conditions are similar and imaging and laboratory studies are of limited value. A combination of radionuclide bone-marrow and bone scans was performed sequentially within a twenty-four-hour period (with one exception) to aid in the differentiation between bone infarction and osteomyelitis in seventy-nine consecutive episodes of acute bone pain in children with sickle-cell disease. Seventy cases of bone infarction were diagnosed on the basis of decreased uptake on the bone-marrow scan and abnormal uptake on the bone scan at the site of pain. Antibiotic administration was discontinued in sixty-six of the seventy cases after the imaging results were obtained, and the bone pain resolved. In four of the seventy-nine cases, there was normal uptake on the bone-marrow scan and abnormal uptake on the bone scan at the site of pain, findings that were suggestive of acute osteomyelitis. In three of these cases, osteomyelitis was proven by culture, and the symptoms in all four resolved with antibiotic treatment. In five of the seventy-nine cases, the bone-marrow and bone scans were normal and thought to indicate neither osteomyelitis nor bone infarction; in all of these cases, the symptoms resolved without the use of antibiotics. These findings suggest that osteomyelitis can be differentiated from bone infarction in children with sickle-cell anemia and acute bone pain by a combination of sequential bone-marrow and bone scintigraphy.

374 HYPERTROPHIC OSTEOARTHROPATHY IN CHILDREN WITH LEUKEMIA

Bone lesions are frequently encountered in children with leukemia as part of their disease or occasionally as consequence of therapy. While leukemic infiltration is a well known cause of bone pain in children, avascular necrosis and osteoporosis can also be responsible for these complaints. The authors present two children with an unusual cause of bone pain in childhood leukemia, hypertrophic osteoarthropathy (HOA). This condition is well known in adults, but is rarely seen in children. The most frequently associated conditions in children are chronic lung, liver or heart disease and sometimes malignant or benign tumors. In a child with acute non-lymphoid leukemia (ANLL) FAB type M7 and in a child with common acute lymphoid leukemia (ALL) - both in the maintenance phase of therapy - bone pain developed. The radiographs showed cortical thickening and periosteal new bone formation along the diaphyses of the long bones. Bone scintigraphy remained negative. MRI showed no signs of residual leukemic infiltration. Both children were in remission at the time of detection of the bone lesions, and did not have any signs of chronic infection. Approximately three months later however - although the bone pain disappeared - the child with ANLL developed a myelodysplastic syndrome (MDS) and the patient with ALL a partial relapse with 12 % blasts in the bone marrow. The occurrence of HOA in children with leukemia, both ANLL and ALL. should instigate repeated bone marrow investigation since it might herald MDS or relapse.