Osteomyelitis Pain:The Hidden Factors Behind It and The Most Effective Treatments

Background: Osteomyelitis is a complex bone infection that presents significant diagnostic and therapeutic challenges in adult orthopedic practice. Pain is not only a primary clinical manifestation but also a determinant of functional impairment and surgical decision-making. Objective: This review aimed to evaluate the pathophysiological mechanisms, diagnostic approaches, and evidencebased protocols for pain management in osteomyelitis, specifically within orthopedic settings. Methods: A narrative review was conducted based on the analysis of 30 peer-reviewed articles published between 2015 and 2025. Studies were selected for their relevance to adult osteomyelitis, pain mechanisms, orthopedic interventions, and multidisciplinary pain control strategies. Results: Pain in osteomyelitis is multifactorial, involving inflammatory, mechanical, and neuropathic components. Diagnostic accuracy depends on clinical assessment combined with advanced imaging and microbiological confirmation. Pain management requires a multimodal approach that includes NSAIDs, opioids, neuropathic agents, surgical debridement, stabilization, local antibiotics, rehabilitation, and psychological support. The integration of these strategies is essential to reduce pain, prevent chronicity, and optimize orthopedic outcomes. Conclusion: Effective pain control in osteomyelitis is critical for functional recovery and long-term patient outcomes. A multidisciplinary, personalized approach—rooted in orthopedic principles—ensures not only infection eradication but also pain resolution and quality of life enhancement.