In many patients osteoporosis causes dull back pack which makes any sporting activities hell. The result is that physical exercise is avoided as much as possible. However, this is devastating for the course of the disease. If bones are not regularly exercised, bone density diminishes even more, and pain and the risk of fractures increase more and more. Good pain therapy can help break this vicious circle.

Dr Gerhard Müller-Schwefe, pain therapist and President of the German Society for Pain Therapy, reported in the Ärzte Zeitung of a 56-year-old woman with osteoporosis who attended his surgery with increasing pain. For six years she had suffered from back pain which had handicapped her more and more.

She used to be very active; she liked to walk and regularly went swimming. However, as a result of the pain, she became more and more inactive. Eventually even breathing in deeply became painful.

Active physical exercise is an essential part of osteoporosis treatment in order to stop the disease progressing. In this disease the proverb: "if you don't use it, you'll lose it" applies especially. If bones are not put under strain, they lose calcium and become more and more brittle. Pain therapy is therefore an important step in achieving effective treatment from the start.

Of course the analgesic must be suited to the patient. For example, many substances are not suitable for patients with high blood pressure or peptic ulcers on account of their side-effects. However, in such cases there should be no fear of treating the pain with strong medicines such as opioids. On the contrary, according to Dr Müller-Schwefe, "opioids are very good in such cases, because they are neither ulcerogenic (editor's remark: do not cause ulcers) nor do they raise blood pressure."

For Dr Müller-Schwefe's patient the right pain therapy is the first step on the road back to an active and fulfilled life. The medicines helped her to take part in an active osteoporosis training programme. Bone density increased considerably, and now, one year after treatment, the patient is even running dancing sessions for the elderly. (BSMO)