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Other causes of pain

Other causes of pain related to Paget’s disease include the following: 

Deformity of the bone
Paget's disease can affect any bone but does not affect every bone in an individual. Pain in Paget's disease is then related to the specific bone/s that have Paget's. This is thought to be due to abnormal stresses on the surrounding tissues and stretching of the membrane surrounding the bone.

Stress fractures
These are small cracks in the bone that tend to occur in deformed weight-bearing bones, such as the thigh bone (femur) and shin bone (tibia).

Fractures
These usually occur as the result of a fall, causing the bone to break. 

Osteosarcoma
This is a very rare type of bone cancer that can occur in people with Paget’s disease.

Pain from Paget’s in the skull
Paget’s disease of the skull can be associated with several symptoms, including headaches and a band-like tightness around the head, resulting in an unpleasant sensation. If the pain is the result of increased metabolic activity of Paget’s disease, then treatment with a bisphosphonate, such as zoledronic acid or risedronate may help the pain. 
People with Paget’s disease can also get headaches as the result of other causes like a migraine. If you have Paget’s disease and you experience headaches, it is important that you speak with your GP or specialist to seek advice on whether they are likely to be due to Paget’s disease or another cause.

Back pain
Back pain is very common. There are many causes, but in older people, it is often due to osteoarthritis affecting the joints of the spine. If osteoarthritis is the cause of the pain, it can be treated by medication. You may also find physiotherapy, acupuncture or TENS helpful, as discussed in our pain booklet, which is available to download from the members' section of our website.
Paget’s disease can also cause back pain as the result of increased metabolic activity of the disease. If this is the case, it may be helped by therapy with a bisphosphonate such as risedronate or zoledronic acid. 
Back pain can also occur as the result of what is called spinal stenosis. This can affect people with Paget’s disease of the spine because the affected bone enlarges, and this can cause pressure on the nerves that emerge from the spinal canal. The main symptom of spinal stenosis is pain, often radiating to the buttocks or down the legs, but there may also be numbness, weakness, and a tingling sensation in the legs. Patients with severe spinal stenosis may experience difficulty walking.   
The diagnosis of spinal stenosis is usually made by an MRI scan. If symptoms are severe or worsening, surgical treatment may be offered to release the pressure (decompression) and give the nerves more room. Surgical treatment can sometimes involve removing sections of the bone or the bones may be fused together.

Osteoarthritis and Paget’s
Osteoarthritis is a common condition, even in people without Paget’s disease. There is evidence that people with Paget’s disease are more prone to develop osteoarthritis in joints adjacent to bones that are affected by Paget’s and the most commonly affected sites are the hip and knee. Paget’s disease is thought to predispose to osteoarthritis for two main reasons. The first is whether there is deformity of the bone. This can place abnormal stresses on the joints nearby. An example would be if a tibia becomes bowed, this can cause shortening of the leg, which can predispose to arthritis of the knee or ankle. The second reason is that the bone in Paget’s disease is denser than normal.  If there is increased density of the bone next to a joint, it results in abnormal strain being put on the cartilage (lining of the joint), causing the surface of the joint to become worn. Read the text tab in this section for further information.

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