Clinical course of pain in acute osteoporotic vertebral compression fractures.
OBJECTIVE
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.


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.
Klazen
Caroline A H
CA
Department of Radiology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, Tilburg, NL 5022 GC, The Netherlands. andrea.tsai@post.harvard.edu
Verhaar
Harald J J
HJ
Lohle
Paul N M
PN
Lampmann
Leo E H
LE
Juttmann
J R
JR
Schoemaker
M C
MC
van Everdingen
K J
KJ
Muller
A F
AF
Mali
W P Th M
WP
de Vries
J
J
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000627:therapeutic use; D001416:Back Pain / Q000209:etiology / Q000628:therapy*; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019637:Orthopedic Procedures; D010024:Osteoporosis / Q000150:complications* / Q000000981:diagnostic imaging; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D000700:Analgesics