Clinical study
Clinical Course of Pain in Acute Osteoporotic Vertebral Compression Fractures

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Purpose

The authors prospectively determined the natural course of pain in patients with conservatively treated acute osteoporotic vertebral compression fractures (VCF). In addition, the type of conservative therapy that these patients received was assessed.

Materials and Methods

Patients older than 50 years, referred for spine radiography for acute back pain, were asked to complete a baseline clinical questionnaire. Patients with an acute VCF were followed up at 6 and 23 months with a questionnaire that included a Visual Analog Score (VAS) and type of pain medication and other conservative treatment. Significant pain relief was defined as a decrease in VAS of 50% or more.

Results

Forty-nine patients (mean age, 78 years; range, 51–95) with acute VCF were followed up for almost 2 years. Significant pain relief was noted in 22 of 35 patients (63%) at 6 months and in 25 of 36 (69%) at 23 months. In patients with persisting pain at 23 months (mean VAS 6.4), some decrease in VAS was apparent at 6 months but not in the 6–23 months interval. No predictors for significant pain relief could be identified. Patients with significant pain relief used less pain medication and had less physical therapy.

Conclusions

In most patients with an acute VCF, pain decreases significantly with conservative therapy, predominantly in the first 6 months. However, almost 2 years after an acute VCF, a third of patients still had severe pain necessitating pain medication and physical therapy in the majority. No predictors for transition from acute to chronic pain could be identified.

Section snippets

Patients

Patients were recruited in two large teaching hospitals (St. Elisabeth Hospital Tilburg and Diakonessenhuis Utrecht) in the Netherlands between December 2004 and September 2005. Patients aged ≥ 50 years and referred by the general practitioner for a thoracic or lumbar spine radiograph were asked to participate in this study. They received a clinical questionnaire at baseline. Patients with a radiographically diagnosed VCF and back pain for 2 weeks or less were included after written informed

Results

Of the 58 patients that were screened between December 2004 and September 2005, 51 met the inclusion criteria, and two declined participation. The remaining 49 patients were included in the study (Fig 1). Baseline characteristics of the enrolled patients are summarized in Table 1.

Discussion

The largest decrease in pain scores occurred within the first 6 months. After 6 months no significant decrease in pain scores was noted. A high VAS at 6 months predicted a high VAS at 23 months. In our study, 37% of the patients had no significant pain relief at 6 months.

The tendency of an osteoporotic VCF to heal within 6 months was also described in another study (10, 11). In this study, all patients presenting in the emergency department or admitted as inpatients with an acute osteoporotic

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None of the authors have identified a conflict of interest.

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