Abstract | PURPOSE: 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.
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Authors | Magdalena Rzewuska, Manuela Ferreira, Andrew J McLachlan, Gustavo C Machado, Christopher G Maher |
Journal | European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
(Eur Spine J)
Vol. 24
Issue 4
Pg. 702-14
(Apr 2015)
ISSN: 1432-0932 [Electronic] Germany |
PMID | 25725810
(Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
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Chemical References |
- Analgesics
- Analgesics, Opioid
- Anti-Inflammatory Agents, Non-Steroidal
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Topics |
- Acute Pain
(etiology, therapy)
- Adult
- Analgesics
(therapeutic use)
- Analgesics, Opioid
(therapeutic use)
- Anti-Inflammatory Agents, Non-Steroidal
(therapeutic use)
- Back Pain
(etiology, therapy)
- Fractures, Compression
(complications, therapy)
- Humans
- Male
- Orthotic Devices
- Osteoporotic Fractures
(complications, therapy)
- Pain Management
(methods)
- Physical Therapy Modalities
- Spinal Fractures
(complications, therapy)
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