Patterns of pain in Paget?s disease of bone and their outcomes on treatment with pamidronate

Abstract

Two-thirds of patients with Paget's disease seeking medical attention present with pain. We studied patterns of pagetic pain in relation to physical activity, and the effect of coexistent osteoarthritis (OA)/pagetic arthropathy on pain and physical activity before and after treatment with pamidronate. Patients with lower-segment Paget's disease (lumbar spine, pelvis or lower limbs), raised alkaline phosphatase (ALP), and pain as a symptom were included. Two subgroups were identified based on the absence (P group), or presence (POA group) of radiological OA in the lower segment. They received 2-4 fortnightly infusions of pamidronate 30-60 mg and were followed up at 6 weeks, 3 months and 6 months. Outcome measures were visual analog scales for pain at rest, on standing, on walking and at night; standing time, walking distance, 50-yard walking time, and ALP. Twenty-five patients (12 men, 13 women, mean age 70.1+/-1.9 years), received a mean of 142+/-9.7 mg of pamidronate. The P group had higher mean ALP (p=0.003) and higher scores for pain (not significant) at baseline than the POA group. Compared to baseline, P group had significant improvements (p<0.01) at 6 months in rest pain, standing pain and walking pain. The POA group had non-significant changes in pain at 6 months. ALP improved significantly at 6 months in both subgroups (p<0.01). The whole group also improved at 6 months in standing time (55.7%, not significant), walking distance (33.9%, not significant), and 50-yard walking time (24.2%, p<0.05). Paget's patients with coexistent joint disease had less severe pain and bone disease at baseline than those without coexistent joint disease, and responded less well to pamidronate, although they did have significant improvement in ALP levels. Radiographic assessment for coexisting joint disease prior to treatment might improve prognostication from the patient's point of view, and improve treatment compliance.

A pilot trial of intravenous pamidronate for chronic low back pain

“…Multiple IV infusions of pamidronate are generally indicated for palliative treatment of painful bone metastasis and in certain painful bone-related conditions such as Paget’s disease and fibrous dysplasia [11,25,30,51]; however, a single infusion of pamidronate has been reported to relieve pain in patients with complex regional pain syndrome, hypertrophic osteoarthropathy and Charcot arthropathy [44,49]. Efficacy and duration of response probably relate to both dose and pharmacokinetic properties of bisphosphonates, which can persist in bone for months [24,27].…”

“…For example, pamidronate (Aredia®, Novartis), an aminobisphosphonate, demonstrates clinically significant pain relief when administered intravenously for treatment of Paget’s disease, metastatic breast cancer and osteolytic lesions of multiple myeloma [6,25,51]. In addition, IV pamidronate has been shown to have analgesic activity in a wide variety of painful conditions, including complex regional pain syndrome (CRPS) [13,44,53], fibrous dysplasia [11], recurrent multifocal osteomyelitis [23,35], ankylosing spondylitis [33], rheumatoid arthritis [31], and others (for review, see [49]).…”

Efficacy and safety of pamidronate in Modic type 1 changes: study protocol for a prospective randomized controlled clinical trial

“…Although this efficacy in spondyloarthropathies remains a topic of discussion, it has nevertheless been clearly demonstrated for various types of bone pain (Paget’s disease [32], fibrous dysplasia of bone [33] and vertebral compression [34,35]). Therefore, we conducted an open-label study on the efficacy of pamidronate in ten patients with EDDD in 2006, with conclusive results [36].…”

Synthesis and biological evaluation of a series of 99mTc‐labeled diphosphonates as novel radiotracers with improved bone imaging

“…99m Tc‐labeled DPs as diagnostic agents have a number of clinical and chemical limitations, such as low selectivity and relatively slow clearance from the blood and soft tissues. These properties usually lead to false negative results and extended intervals (2–6 h) between injection and bone imaging .…”