FD Pain Review Upadyay 2023
Pain in FD/MAS represents one of the most prominent aspects of the disease and one of the most challenging to treat—an outcome driven by (i) the heterogeneous nature of FD/MAS, (ii) the variable presentation of pain phenotypes (i.e., craniofacial vs. musculoskeletal pain), (iii) a lack of studies probing pain mechanisms, and (iv) a lack of rigorously validated analgesic strategies in FD/MAS. At present, a range of pharmacotherapies are prescribed to patients with FD/MAS to mitigate skeletal disease activity, as well as pain. We analyze evidence guiding the current use of bisphosphonates, denosumab, and other therapies in FD/MAS, and also discuss the potential underlying pharmacological mechanisms by which pain relief may be achieved. Furthermore, we highlight the range of presentation of pain in individual cases of FD/MAS to further describe the difficulties associated with employing effective pain treatment in FD/MAS. Potential next steps toward identifying and validating effective pain treatments in FD/MAS are discussed, such as employing randomized control trials and probing new pain pathways in this rare bone disease.
Anthony Tucker-Bartley 1,2 , Daryl J. Selen 3, Emma Golden 1, Raquel van Gool 1, David Ebb 4, Michael Mannstadt 5 and Jaymin Upadhyay 1,6,*
1 Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital,
Harvard Medical School, Boston, MA 02115, USA
2 Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
3 Division of Endocrinology, Department of Medicine, Warren Alpert Medical School of Brown University,
Providence, RI 02903, USA
4 Department of Pediatric Hematology Oncology, Massachusetts General Hospital, Harvard Medical School,
Boston, MA 02115, USA
5 Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
6 Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
* Correspondence: jaymin.upadhyay@childrens.harvard.edu
