Treating Pain Associated with Paget’s Disease of Bone?
Many patients who have pain directly from active Paget's disease experience a reduction in pain with bisphosphonate treatment.
Bisphosphonates are the main treatment for Paget's disease, are effective in reducing bone turnover and when pain is associated with active Paget’s disease, they often provide excellent pain relief. The bisphosphonates commonly used in the UK are:
• Zoledronate 5mgs (e.g. Aclasta). This is the most commonly used treatment and is given intravenously (directly into the bloodstream).
• Risedronate 30mgs (e.g. Actonel). Taken orally for 2 months
Analgesics - Most people with Paget’s disease require painkillers (analgesics) as well as bisphosphonates to control pain, especially if the disease has led to damage to the bones and joints. You should always start with small doses of drugs such as paracetamol, that can be gradually increased or changed to stronger drugs until you have the best possible pain relief.
Nerve pain - Pain in Paget’s disease may also be associated with compression of a nerve. Specific drugs which aim to block this type of pain can be used. These are often drugs that were originally created to treat other illnesses, such as depression (e.g. amitriptyline) or epilepsy (e.g. gabapentin), but they are now commonly used to treat pain associated with the nerves.
Calcitonin - For pain directly from active Paget's disease, when the above measures do not adequately relieve pain, calcitonin is occasionally used.
Surgery - Few people with Paget’s disease ever need surgery, but successful surgical management of severe complications can reduce pain and improve quality of life. For example, joint replacement may be necessary for osteoarthritis and fractures may require surgery to repair the bone.
Physiotherapy - Physiotherapists help people through movement and exercise, manual therapy, education and advice. They can also advise on the use of walking aids. Your GP can refer you to a physiotherapist.
Specialised footwear - The orthotics department of your hospital can sometimes help by providing specialised footwear when there is deformity in the leg/s.