Quantitative Sensory Testing Reveals Evidence of Altered Pain Processing in Paget’s Disease of Bone

Pain is the most common symptom of Paget's disease of bone (PDB), but its underlying mechanisms are poorly understood. Notably, bone pain does not correlate well with metabolic activity or treatment response. This study aimed to assess whether sensory processing is altered in skin overlying Pagetic bone using quantitative sensory testing (QST). We conducted a cross-sectional study of 156 people with PDB attending secondary care referral centres in the UK. We conducted quantitative sensory testing of the skin overlying affected sites and compared the data with unaffected sites as a control. The modalities used were hot and cold rollers, pinprick, vibration and von-Frey filaments to test both spinothalamic and lemniscal pathways. There was a consistent trend for sensory perception to be increased over affected sites versus control sites in the study population. The differences were significant for vibration detection threshold (p = 0.009), pain threshold (p = 0.010) and both single and multiple pinprick testing methods (both p < 0.001). Subgroup analysis revealed similar trends when analysis was restricted to those with pain thought to be due to bone deformity or increased metabolic activity and those with and without musculoskeletal pain. Sensory processing is altered in skin overlying Pagetic bone, independent of current pain symptoms. We speculate that this may be due to abnormalities of bone shape, bone structure or metabolic abnormalities in the affected bone. The mechanisms are unclear but deserve further study.

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Publication Details

Journal
Calcified Tissue International
Published
2025-12-18
DOI
https://doi.org/10.1007/s00223-025-01456-9
Primary Topic
Bone health and treatments
Type
article
Field-Weighted Citation Impact
0.00

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article

Quantitative Sensory Testing Reveals Evidence of Altered Pain Processing in Paget’s Disease of Bone

Terence W O’Neill, Jonathan Tang, Terry Aspray, David H. Dockrell et al.
Calcified Tissue International
Bone health and treatments
article

Quantitative Sensory Testing Reveals Evidence of Altered Pain Processing in Paget’s Disease of Bone

Terence W O’Neill, Jonathan Tang, Terry Aspray, David H. Dockrell, Hrushikesh Divyateja, Lesley Colvin, E Hanison, Stuart H. Ralston, Kathryn Berg, Nazim Ghouri, Richard Keen, Jane F. Turton, Elaine Dennison, Stephen Tuck, Eugene McCloskey, Mashood Siddiqi, Faizanur Rahman
article en

Abstract

Pain is the most common symptom of Paget's disease of bone (PDB), but its underlying mechanisms are poorly understood. Notably, bone pain does not correlate well with metabolic activity or treatment response. This study aimed to assess whether sensory processing is altered in skin overlying Pagetic bone using quantitative sensory testing (QST). We conducted a cross-sectional study of 156 people with PDB attending secondary care referral centres in the UK. We conducted quantitative sensory testing of the skin overlying affected sites and compared the data with unaffected sites as a control. The modalities used were hot and cold rollers, pinprick, vibration and von-Frey filaments to test both spinothalamic and lemniscal pathways. There was a consistent trend for sensory perception to be increased over affected sites versus control sites in the study population. The differences were significant for vibration detection threshold (p = 0.009), pain threshold (p = 0.010) and both single and multiple pinprick testing methods (both p < 0.001). Subgroup analysis revealed similar trends when analysis was restricted to those with pain thought to be due to bone deformity or increased metabolic activity and those with and without musculoskeletal pain. Sensory processing is altered in skin overlying Pagetic bone, independent of current pain symptoms. We speculate that this may be due to abnormalities of bone shape, bone structure or metabolic abnormalities in the affected bone. The mechanisms are unclear but deserve further study.

Calcified Tissue InternationalVol. 117(1)
University of East Anglia (GB), Nottingham University Hospitals NHS Trust (GB), University of Nottingham (GB), University of Liverpool (GB), University of Dundee (GB), Norfolk and Norwich University Hospital (GB), Western General Hospital (GB), Norfolk and Norwich University Hospitals NHS Foundation Trust (GB), James Cook University Hospital (GB), Northern General Hospital (GB), University Hospitals of Leicester NHS Trust (GB), Ninewells Hospital (GB), Edinburgh Cancer Research (GB), Royal National Orthopaedic Hospital (GB), Royal Liverpool University Hospital (GB), Nottingham City Hospital (GB), NIHR Southampton Biomedical Research Centre (GB), NIHR Newcastle Biomedical Research Centre (GB), University Hospital Llandough (GB), MRC Lifecourse Epidemiology Unit (GB), Genomics (United Kingdom) (GB), Queen Elizabeth University Hospital (GB), NIHR Manchester Biomedical Research Centre (GB), University of Southampton (GB), University College London (GB), University of Glasgow (GB), University of Sheffield (GB), University of Edinburgh (GB)
European Commission, Horizon 2020 Framework Programme
Openalex Percentile: Top 43%
Bone health and treatments
DOIOpen Access PDFOpenAlex
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