P OSTEOID OSTEOMA X ASPIRIN

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Role of Aspirin in Osteoid Osteoma

Osteoid osteoma is a benign bone tumor that characteristically causes intense, localized pain, especially at night. The hallmark feature is that the pain responds dramatically to NSAIDs, particularly aspirin.

Why Aspirin Helps

1. High Prostaglandin Production

   • The nidus of an osteoid osteoma produces very high levels of prostaglandins (up to 100–1000× higher than normal bone).

   • These prostaglandins are responsible for the severe pain.

2. Aspirin Inhibits Prostaglandin Synthesis

   • Aspirin (and other NSAIDs) inhibits cyclo-oxygenase (COX) enzymes.

   • This reduces prostaglandin production in the nidus, leading to rapid and significant pain relief.

Clinical Significance

• Pain relief with aspirin/NSAIDs is a classic diagnostic clue.

• Historically, long-term NSAID therapy was used to control symptoms until the lesion resolved over several years.

• Today, definitive treatment is typically CT-guided radiofrequency ablation (RFA), but NSAIDs (including aspirin) remain useful for symptom management.

Key Point

Marked pain relief after taking aspirin is a characteristic and almost pathognomonic feature of osteoid osteoma.