Pain Relief by Bone Drilling and Osseous Pain Sensitization: A Hypothesis

Abstract

Bone drilling (BD) is reconsidered to be a novel treatment for pain including vertebral compression fracture (VCF), vertebral spondylosis, osteoarthritis (OA) and osteonecrosis of the knee and hip, and neuropathic pain. BD is simple and harmless. The technique of BD is the similar to that of bone marrow puncture. BD is conducted under X-ray fluoroscopy and regional anesthesia. Exact penetration of bone cortex is required for intramedullary decompression, and sufficient aspiration of medullary blood is important to eliminate intramedullary inflammatory cells (ICs) and inflammatory chemical mediators (ICMs). Onset of the effect is immediate, and the effect lasts several months or a few years. However, precise of the underlying mechanisms of BD is remained unclear. On the other hand, effectiveness of BD was also shown in neuropathic pain, a representative of complex regional pain syndrome (CRPS.) Neuropathic pain was induced after the nerve root injury, and the bone is generally intact. However, BD alleviates a foot ache that is produced thereafter. This fact may indicate that subsequent medullary inflammation occurs and bone tissue is involved in CRPS. Therefore, a certain change within the bone is induced by CRPS. The fact suggests a hypothesis that a self-facilitating mechanism of pain is provided independently within bone marrow. We term this mechanism 'osseous pain sensitization'. Also medullary ICs cause bone resorption, and the ultimate bone dystrophy due to CRPS may be 'Sudeck dystrophe'.