The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: a systematic review with meta-analysis.
OBJECTIVE
The aim of this study is to systematically evaluate the efficacy of commonly used non-surgical treatments in acute care of adults with osteoporotic vertebral compression fractures (VCFs).


METHODS
A systematic approach was used to search eight electronic databases for randomized controlled trials (RCTs) examining analgesic medications, passive physical therapies, bed rest or orthoses. Data on pain, activity/participation and adverse events were extracted. Methodological quality and quality of evidence were assessed with the Physiotherapy Evidence Database (PEDro) scale (score range 0-10) and the GRADE criteria, respectively.


RESULTS
Five RCTs (total n = 350) were identified including one placebo-controlled and four controlled trials examining analgesics (2 studies) and orthoses (3). PEDro scores ranged from 4 to 7. The overall quality of evidence ranged from very low to low. In two trials, spinal orthoses provided significantly higher medium-term pain relief [pooled standardized mean differences (SMD): -1.47, 95 % confidence interval (CI) -1.82, -1.13; I (2) = 0 %] and disability reduction (pooled SMD: -1.73, 95 % CI -2.09, -1.37; I (2) = 0 %) than no intervention. Immediate- and short-term pain effects of diclofenac (a non-steroidal anti-inflammatory drug) and tramadol (a strong opioid) were demonstrated when compared to a Chinese medicine, whereas non-significant effects were found for oxycodone and tapentadol (strong opioids) in a placebo-controlled trial. Low/insufficient statistical power, co-interventions and potential conflict of interest might have influenced the results.


CONCLUSIONS
At present, there is insufficient evidence to inform conservative care for acute pain related to VCF. Large, multinational, placebo/sham-controlled trials to address this gap in evidence are needed.
The George Institute for Global Health, Sydney Medical School, Missenden Road, Camperdown, PO Box M201, Sydney, NSW, 2050, Australia, mrzewuska@georgeinstitute.org.au.
Magdalena
M
Rzewuska
Manuela
M
Ferreira
Andrew J
AJ
McLachlan
Gustavo C
GC
Machado
Christopher G
CG
Maher
D059787:Acute Pain / Q000209:etiology / Q000628:therapy; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001416:Back Pain / Q000209:etiology / Q000628:therapy*; D050815:Fractures, Compression / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D009989:Orthotic Devices; D058866:Osteoporotic Fractures / Q000150:complications / Q000628:therapy*; D059408:Pain Management / Q000379:methods; D026741:Physical Therapy Modalities; D016103:Spinal Fractures / Q000150:complications / Q000628:therapy*
D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal