Bone Pain in Fibrous Dysplasia When Intravenous Bisphosphonate Switch Did Not Improve Pain Scores

This protocol applies to patients with bone pain in fibrous dysplasia who do not have neuropathic pain features — specifically, the absence of burning or stabbing pain.

Previous treatment — goals not met

Switching to the alternative intravenous bisphosphonate was used in the prior step, but improvement in bone pain VAS score was not achieved. This protocol defines the approach taken after that failure.

Treatment direction

Once bone-directed therapies have been trialled without adequate relief, the protocol addresses escalation to a specific class of analgesics — the criteria, sequence, and conditions for use are detailed inside. The clinical goal is bone pain relief.

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References

DOI: 10.1186/s13023-019-1102-9

Bone therapies should be tried before recommending tramadol and other opioids.
For analgesics, consider paracetamol/acetaminophen as first line, followed by NSAIDs, if benefits outweigh cardiovascular, renal and gastro-intestinal risk.
If neuropathic features such as burning or stabbing pain are present, consider an atypical analgesic ladder, e.g. amitriptyline, gabapentin, pregabalin and duloxetine.
The strategy is to induce symptom remission.

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