Pain attribution and management in non-aggressive bone tumors.

Abstract

e23502 Background: Non-aggressive bone tumors represent approximately 50-60% of surgically treated bone tumors. While osteoid osteomas and chondroblastoma's are well-documented sources of pain, other non-aggressive bone tumors do not have well-defined pain profiles. Understanding the origin of pain in these cases is challenging, particularly when other musculoskeletal conditions are present. This study evaluates the efficacy of corticosteroid injections versus surgical intervention in alleviating pain, aiming to clarify whether pain originates from the bone tumor itself or associated musculoskeletal conditions. Methods: We performed a retrospective review of 37 patients with non-aggressive bone tumor diagnoses located in extremities. Diagnosis was confirmed via core needle/excisional biopsy. Patient demographic, BMI, tumor diagnosis/location, orthopedic comorbidities, pain relief following corticosteroid injections, surgery type, and postoperative surgical pain outcomes were assessed. Results: Diagnoses included enchondroma (15, 40.5%), fibrous dysplasia (8, 21.6%), chondromyxoid fibroma (7, 18.9%), grade 1 chondrosarcoma (6, 16.2%), and non-ossifying fibroma (1, 2.7%). Lesions were located in the femur (8, 21.6%), humerus (8, 21.6%), tibia (6, 16.2%), hand (4, 10.8%), pelvis (4, 10.8%), foot (4, 10.8%), fibula (2, 5.4%), and clavicle (1, 2.7%). All 37 (100.0%) patients reported pain on presentation. Nine (24.3%) patients had a comorbid orthopedic diagnosis in the joint nearest to their bone tumor, 6 (16.2%) of which were osteoarthritis and 3 (8.1%) were tendinitis. Among the 37 patients diagnosed with non-aggressive bone tumors, 7 (19%) received a pretreatment steroid injection, while 30 (81%) did not. Of the 7 patients who received injections, 5 (71%) claimed improved pain relief, while 2 (29%) denied improvements. Four patients who reported initial improvement of pain following steroid injection, reported the pain returned weeks after injection and ultimately underwent surgery with further pain improvement. Among the original 37 patients, 34 (92%) underwent surgery, while 3 (8%) did not. Of the 34 patients who underwent surgery, 31 (91%) reported pain improvement, while 3 (9%) denied any improvement. Conclusions: Corticosteroid injections are not always reliable diagnostic tools in determining the cause of pain in non-aggressive bone lesions. When the pain source remains unclear, surgical intervention resulted in a high rate of pain improvement, suggesting that the primary source of pain is often the tumor itself rather than the associated musculoskeletal condition. This is the first study to specifically address the origin of pain presentation in patients with various non-aggressive bone tumors, presenting a foundation for further investigations into optimal treatment strategies.