Bone healing and opioids homework help
Bone fractures are usually painful and in general temporary disabling injuries that occur after an accident or as a result of various pathologic conditions. Such conditions include osteoporosis or bone invading cancer which is also known as pathologic fracture.
Bone pain is the extreme tenderness, aching, or other discomforts in bones. This pain differs from muscle and joint pain because it is present whether you are mobile or not. This kind of pain is commonly linked to
Opioids- are a class of drugs naturally found in the opium poppy plant that works in the brain to produce several effects including the relief of pain. They can be strong prescription pain relievers often referred to as painkillers or they can also be referred to as street medicine such as heroin and cocaine.
Causes bone pain
Many conditions and events can lead to bone pain and they include:
- An injury- this is the most common cause of bone pain and it arises when a person goes through some form of trauma such as a fall or a car accident. As a result, the bone may break or fracture hence causing pain.
- Mineral deficiency-for the bones to stay strong and healthy, they need a variety of minerals and vitamins which include calcium and vitamin D. a deficiency in both vitamin D and calcium can lead to osteoporosis which is the most common type of bone disease. Late stages of osteoporosis cause pain.
- Metastatic cancers- this is a type of cancer that begins in one part of the body and then spreads to other parts of the body. Cancers of the breast, lungs, thyroid, prostate, and kidneys commonly spread to the bones causing pain.
- Bone invading cancer- this is a situation whereby cancer cells originate in the bone itself. This type of cancer is rarer than metastatic cancers that cause bone pain. Bone cancer can cause pain when cancer destroys the bone’s structure.
Diseases that disrupt the blood supply to the bones hence causing pain
Some of the diseases that cut off blood supply to the bones and end up causing bone pain include:
- Sickle cell anemia
Diseases like sickle cell anemia interfere with the blood supply to the bone. Without a steady supply of blood, the bone tissue starts to die, hence causing a lot of pain and weakening of the bone.
An infection that originates in the bones or spreads to the bones can cause a serious condition known as osteomyelitis. This kind of bone infection can kill bone cells hence causing pain.
It is a cancer of the bone marrow. Bone marrow is usually found in the bones and is responsible for the production of bone cells. People with leukemia usually experience bone pain, especially in the legs.
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Types of bone diseases
The following are the most common diseases that affect the bones:
- Osteoporosis- is the most common bone disease. The bones become brittle and weak hence prone to breaking easily. It is higher in women than men and even some children may be at risk of developing child osteoporosis. Bone density problems occur because the body loses too much bone tissue, makes too little of it, or sometimes it is a combination of both.
- Paget’s disease- is a bone disorder where the bone renewal process occurs too quickly leading to deformities which include: soft enlarged bones of the spine, skull, pelvis, the bones of thighs, and lower legs. This disease may have a hereditary component.
- Bone infection- it is also known as osteomyelitis which is an infection of the bone tissue and is normally a serious condition. It may occur as a result of surgery such as hip replacement or may end up spreading to the bones from other parts of the body. Common symptoms of this infection include redness, swelling, and pain, and is commonly treated with antibiotics. In some cases, the part of the bone that is infected needs to be surgically removed.
- Osteonecrosis- is a bone disease that causes the bone tissue to die because of a lack of blood supply. This disease occurs as a result of trauma to the bone that disrupts blood flow to the bone such as a hip fracture. Prolonged high doses of steroids use can cause this type of bone cell death. As a result of the death of the cell tissue, the bone weakens and collapses causing pain that gradually gets worse.
- Bone tumors- they occur when the uncontrolled growth of cells occurs inside the bones. such tumors can be benign or malignant. Benign tumors are non-cancerous while malignant tumors are cancerous. Benign tumors that do not impinge on other bone tissue and do not spread are the most common.
- Osteoarthritis- is a degenerative joint disease that is the most common type of arthritis. It occurs when the cartilage that acts as a cushion between the bones breaks down and the bones rub together causing pain, stiffness, and inflammation.
- Rheumatoid arthritis- is a chronic immunodeficiency disorder in which the immune system mistakenly attacks the body’s tissues such as the joints in the hands and the feet. Rheumatoid arthritis affects the lining of the joints causing a painful swelling that can eventually result in bone erosion and joint deformity.
- Scoliosis- it is a condition in which the bones of the spine curve abnormally to the left or the right and just strike before puberty. In most cases, the spinal deformities get worse with time. The cause of scoliosis is usually unknown although it is suspected to be hereditary.
- Low bone density- it is also known as osteopenia and is diagnosed when a person’s bone density is lower than it should be. Low bone density can lead to fractures, pain, and a stooped appearance. It is therefore important to improve bone density if you are diagnosed with osteopenia.
- Gout- it Is a disease that usually affects the joints whereby excess uric acid crystals accumulate in the joints, causing abnormal swelling, pain, and redness. Gout may occur as a result of your diet or if your kidneys are not able to properly process uric acid.
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Causes of bone diseases
- Genetics – most of the metabolic bone diseases like osteogenesis. Imperfecta, osteocalcin, and skeletal dysplasia are usually inherited. Most diseases of the skeletal system are considered congenital because they are either evident at birth or manifest soon after birth.
Genetic factors play a big role in many diseases and often the factors associated with genetic bone diseases are not known and predictable.
- Age- most changes to the bones occur as you age. Osteoporosis is a condition that causes the bones to become weak and brittle and is often diagnosed in older adults. This happens because of reduced bone density causing bones to break more easily. Aging is also a primary cause of osteoarthritis which is a wear and tear type of arthritis where the flexible tissue called the articular cartilage at the end of the bones breaks down leading to permanent bone and joint damage.
- Ethnicity and race- there are always differences in bone diseases between ethnic groups which are related to body size and composition. Some genetic bone diseases like Paget’s disease is a bone disease that affects people of one ethnic group more than the other.
- Sex- women have a higher risk of inflammatory arthritis and osteoporosis. Inflammatory arthritis conditions are known for affecting more women than men. This is due to biomechanics and hormones. In terms of biotechnics, many factors in women contribute to the risk of osteoporosis arthritis including wider hips, childbirth, more flexible joints, etc.
- Occupation- occupational bone diseases are rare although in most cases osteoarthritis has some occupational risk associated with it. Having a physical workload is one of the common occupational risk factors of osteoarthritis. A job that entails regular kneeling, stair climbing, bending, and other repetitive movements. Having a genetic disposition for osteoarthritis can also be a contributing factor to this disease.
- Environmental factors- bone health can be affected by certain toxins which include exposure to heavy metals, asbestos, fungal toxins, chlorine, nicotine, environmental pollutants, and occupational chemical exposure. Exposure to toxic chemicals and environmental toxins contributes to autoimmunity related to inflammatory arthritis.
- Bacteria and infections- some infectious bone diseases like osteomyelitis are caused by bacteria known as staphylococcus bacteria. Bacterial infections of the bone or bone marrow can be quite dangerous especially if left untreated and they can also contribute to some types of inflammatory arthritis.
- Inflammatory arthritis- some types of inflammatory arthritis can contribute to the development of bone conditions like osteoporosis, osteoarthritis, and osteopenia. Osteoarthritis occurs when inflammatory arthritis causes joint damage and cartilage breakdown, while Rheumatoid arthritis is often connected to osteoarthritis over other forms of inflammatory arthritis.
- Diabetes and other hormone diseases- can lead to inflammation that eventually causes osteoarthritis. If diabetes is left uncontrolled, it can lead to the breakdown of joints and bones causing OA and osteoporosis. People with type 1 diabetes tend to have lower bone quality and an increased risk for fractures. Some hormone disorders also affect the human skeleton. Overactive hyperthyroidism can lead to excessive bone breakdown and increase the risk for fractures.
Risk factors for bone diseases
The following are some of the risks for bone disease:
- Unhealthy diet- a diet that is low in vitamin D and calcium can greatly increase the risk for osteopenia or osteoporosis. Vitamin D facilitates the absorption of calcium while calcium is an essential nutrient in the formation of healthy strong bones. Reduced intake of calcium can contribute to reduced bone density, early bone loss, and increased risk for fractures.
- Sedentary lifestyle- people who are not physically active are at a greater risk of developing arthritis and osteoporosis compared to those who are active. Physical inactivity also contributes to many chronic illnesses which can be detrimental to your health.
- Watching your body weight- maintaining a healthy body weight helps to manage your bone health. It is important to ask your healthcare provider about your ideal weight so that you can be able to stay healthy.
- Smoking- is a risk for osteoarthritis, low bone density conditions, and inflammatory arthritis. Smoking can also increase the risk of fractures and increase the time it takes to heal from a fracture.
- Some medications- the usage of some medications for a long time can make it harder to absorb calcium hence leading to damage to bones. Some of these medicines include corticosteroids used to treat mood disorders, hormonal contraceptives, ani-seizure medicines, proton pump inhibitors, etc.
- Consuming excessive alcohol- heavy consumption of alcohol contributes to decreased bone remodeling increasing the risk of fractures hence delaying the healing of fractures. Alcohol can also interfere with the balance of calcium and the production of vitamin D.
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Treatment for bone pain
After the doctor has determined the cause of bone pain, the next step is treatment. The patient may be advised to rest the affected area as much as possible and is likely to be prescribed a pain reliever for the pain. Treatment options for bone pain include:
- Use of pain relievers- they are among the commonly used medicines to reduce pain although they do not cure the underlying condition. Over-the-counter pain killers like ibuprofen or Tylenol can be used. Paracetamol or morphine can be used for moderate to severe pain.
- Use of antibiotics- they are used to treat a bone infection to kill the germs causing the infection. They include clindamycin, vancomycin, and ciprofloxacin.
- Nutritional supplements-conditions like osteoporosis need a replacement of calcium and vitamin D. Patients with this condition are given nutritional supplements to treat the mineral deficiency. they can be available in pills, liquids, or chewable forms.
- Treatments for cancer- bone pain that is caused by cancer is hard to treat hence the doctor has to treat cancer to reduce the pain. Common cancer treatments include radiation, chemotherapy, and surgery. Bisphosphonates are a type of medication that helps to prevent bone damage and bone pain in people with metastatic bone cancer. Opioid pain relievers can also be administered.
- Surgery- sometimes surgery may be needed to remove some parts of the bone that have died due to infection. It may also be needed to remove tumors caused by cancer and also reconstructive surgery may be needed in severe cases where joints can be replaced
Side effects of using opioids for bone healing
- Risk of bone fractures- opioids increase the risk of bone fractures in old people.
- Endocrine system- opioids interfere with the endocrine system hence increasing the risk for osteoporosis.
- Mental confusion and sedation- they can cause sleepiness or mental clouding which can increase the risk of falls and fractures.
- Abnormal breathing- high doses of opioids can cause slow, shallow, or change breathing patterns during sleep.
- Constipation- older people are more likely to experience this problem. The use of opioids makes it worse.
- Heart problems- opioids increase the risk of heart failure and heart attack.
- Nausea- nausea which is a result of opioids makes it difficult to feed well and maintain good nutrition. This happens when there is stimulation on the chemoreceptor trigger zone which detects noxious chemicals in the blood and sends signals to the vomiting center in the medulla, which then initiates the vomiting reflex.
- Urinary retention- they are the anticholinergic side effect of opioids and can be secondary to opioid-induced constipation.
- Central nervous system adverse effects- the combination of opioids and other central nervous system drugs eg. Barbiturates, antidepressants, and antipsychotics can have addictive effects on sedation.
- Pruritis- it happens in a small number of old people with opioid use and it resolves in one week.
- Respiratory depression- opioids are the cause of an unwanted side effect which is marked by depression of breathing that can complicate their clinical administration and can be potentially life-threatening as the pattern of breathing becomes shallower and slower.
- Opioid-induced hyperalgesia- patients who receive large doses of opioids may develop opioid-induced hyperalgesia which is the increase of sensitivity to both pain and non-painful stimuli
Pain management cannot be disregarded in the daily struggle that doctors face in treating their patients. Among the many types of pain, bone pain cannot be underestimated but should be fought against by using all means available. Patients too need to be treated depending on the severity of the pain they experience. NSAIDs should be used to treat acute pain but not chronic pain. Opioids can be used to treat chronic in their most recent formulations as they can guarantee fewer side effects. Patients need to be prescribed adjuvant drugs as well as be given support to ensure successful treatment.
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