Osteoporosis

Pain and medication in osteoporosis

Osteoporosis is often referred to as a 'silent condition' and often a fracture is the first symptom that leads to investigation and diagnosis of the condition. Pain is not a symptom of osteoporosis in the absence of fractures. Patients may confuse osteoporosis with degenerative conditions such as osteoarthritis and it is the later that is frequently responsible for pain.
 
Pain is not a universal feature amongst people diagnosed with osteoporosis. We found that amongst the people we talked to the impact of pain on their everyday life and ability to do things differed a lot. It ranged from those who reported having no pain to those who experienced it daily. However, most of the people we talked to do take some form of pain relief medication. Many take the occasional painkiller bought over the counter while several have specific pain relieving prescriptions and hospital treatments for pain relief.
 
Many people were able to manage pain by taking painkillers that did not need a prescription, such as low-strength co-codamol and paracetamol. While some said they take painkillers as and when needed, others thought that it was better to be ‘ahead’ or ‘on top’ of the pain by anticipating the possible impact that certain activities will have on their pain level. So people would take a painkiller before going out shopping, walking or for an evening out. Others prefer to take pain relief at night to try and get a good night sleep.
Many people were unwilling to depend on painkillers because they didn’t want to be seen as ‘pill poppers’, and the thought of becoming dependent on pain medication concerned them. Some people were already taking several other medications and others were worried about side effects. Several people indicated that they preferred to use external medication in the form of gels to alleviate their pain.
  
Notably, it was elderly people who were most reticent to take medication for their pain. Beryl said that she only takes her prescribed medication if the pain is bad. By not taking or reducing the number of tablets they take in a day the elderly people we talked to felt more in control and felt they were keeping their independence. Of course, the level of pain varied and a few elderly people eventually consented to have pain relief treatment.
Some medications do interact with one another making it impossible for doctors to prescribe stronger pain relief that could be more effective at alleviating pain. Several people were also restricted because of other illnesses. Ann has coeliac disease and has to limit the dose of codeine she takes and Rose cannot take Ibuprofen because of her Mastocytosis.
People who took prescribed pain relief medication commented that it can take time to find the medication that could effectively deal with their pain. Robert commented that in his experience it was a question of ‘trial and error to get the drug cocktail right’. In several cases people indicated that their level of pain has worsened and they had to be prescribed a stronger medication to help them deal with it. A few people commented that their doctors were reluctant to prescribe pain medication.
People on strong pain relief medication commented that one of the downsides of it was the effect it had on their everyday life. They said that they felt dizzy and tired which made them more susceptible to falls. Moreover, Robert indicated that in his experience the effect of the pain relief started to wear off and doctors needed to prescribe even stronger drugs.
So with the advice and support from their consultants people tried to find a treatment that allowed them to strike a balance between a level of pain they could live with in return for a better quality of life. David said that he doesn’t want to be drugged ‘up to his eyeballs’.
Pain clinics
Pain clinics aim to give patients relief when pain is particularly bad and help people to become more mobile. Pain clinics vary in the treatments offered and not all hospitals have a specific pain clinic. Some are run by a consultant with a special interest in pain, others also have a physiotherapist, a nurse or a psychologist. Very few of the people we talked to attended a pain clinic for assessment and medical treatments or, for prescription of specific pain relieving medication.
The experiences of those who attended a pain clinic varied, mainly because their medical problems were different. In 2007 Cressida was admitted to hospital for rehabilitation and pain relief treatment. She complained of generalised pain, especially in the pelvis, hip, thoracic and lumbar spine. She had physiotherapy and hydrotherapy and was started on a buprenorphine patch. She says that the morphine patches have ‘changed my life’. After her kyphoplasty, Noreen continued experiencing back pain which she attributes to ‘wear and tear’ and also to her own attitude of not pacing herself. There wasn’t much the pain clinic could do for her because many of the treatments had side effects that she couldn’t cope with. Her only option was a nerve block injection but it contained steroids, so it had to be ruled out. So she was offered acupuncture treatment but it had minimal impact in alleviating her pain. She was then invited to attend a six week pain management programme but it was a distance to drive to, so she has postponed attending the programme for the time being.
Pain management programmes
These programmes have been designed to assist people whose lives have been negatively affected by persistent pain. Unlike pain clinics it does not aim to relieve pain through the use of medication, but it is a psychologically-based treatment that aims to reduce disability and pain by teaching physical, psychological and practical techniques to improve a person’s quality of life. These types of programmes are usually delivered in a group setting by an interdisciplinary team of healthcare professionals. People are usually referred to a pain management programme by their local pain clinic.
Robert’s consultant at the pain clinic suggested he attended a chronic pain management programme to help him deal with his everyday life, persistent pain and his depression. He said that the pain management programme taught him three things' to manage his pain, his lifestyle and the image of his pain.
Several people we talked to said that symptoms like pain, tiredness, immobility and fatigue had led to depression (see also Feelings and thoughts about osteoporosis).


 
 

Last reviewed July 2013
Last updated October 2013

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