The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief

a systematic review with meta-analysis

Magdalena Rzewuska (Corresponding Author), Manuela L Ferreira, Andrew J McLachlan, Gustavo C Machado, Christopher G Maher

Research output: Contribution to journalArticle

22 Citations (Scopus)

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; I2 = 0 %] and disability reduction (pooled SMD: −1.73, 95 % CI −2.09, −1.37; I2 = 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.
Original languageEnglish
Pages (from-to)702-714
Number of pages13
JournalEuropean Spine Journal
Volume24
Issue number4
DOIs
Publication statusPublished - Apr 2015

Fingerprint

Compression Fractures
Orthotic Devices
Osteoporotic Fractures
Acute Pain
Meta-Analysis
Placebos
Pain
Opioid Analgesics
Analgesics
Randomized Controlled Trials
Databases
Confidence Intervals
Oxycodone
Tramadol
Conflict of Interest
Bed Rest
Diclofenac
Anti-Inflammatory Agents
Medicine
Therapeutics

Keywords

  • systematic review
  • ertebral compression fracture
  • conservative treatment
  • analgesics
  • orthoses

Cite this

The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief : a systematic review with meta-analysis. / Rzewuska, Magdalena (Corresponding Author); Ferreira, Manuela L; McLachlan, Andrew J; Machado, Gustavo C; Maher, Christopher G.

In: European Spine Journal, Vol. 24, No. 4, 04.2015, p. 702-714.

Research output: Contribution to journalArticle

Rzewuska, Magdalena ; Ferreira, Manuela L ; McLachlan, Andrew J ; Machado, Gustavo C ; Maher, Christopher G. / The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief : a systematic review with meta-analysis. In: European Spine Journal. 2015 ; Vol. 24, No. 4. pp. 702-714.
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abstract = "PurposeThe 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).MethodsA 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.ResultsFive 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; I2 = 0 {\%}] and disability reduction (pooled SMD: −1.73, 95 {\%} CI −2.09, −1.37; I2 = 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.ConclusionsAt 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.",
keywords = "systematic review, ertebral compression fracture, conservative treatment, analgesics, orthoses",
author = "Magdalena Rzewuska and Ferreira, {Manuela L} and McLachlan, {Andrew J} and Machado, {Gustavo C} and Maher, {Christopher G}",
note = "Prof. Maher is supported by the Australian Research Council. Dr. Ferreira holds a Career Development Award at The George Institute for Global Health. Mr Machado holds the International Post-graduate Research Scholarship-Post-graduate Award from the Australian Government.",
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T1 - The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief

T2 - a systematic review with meta-analysis

AU - Rzewuska, Magdalena

AU - Ferreira, Manuela L

AU - McLachlan, Andrew J

AU - Machado, Gustavo C

AU - Maher, Christopher G

N1 - Prof. Maher is supported by the Australian Research Council. Dr. Ferreira holds a Career Development Award at The George Institute for Global Health. Mr Machado holds the International Post-graduate Research Scholarship-Post-graduate Award from the Australian Government.

PY - 2015/4

Y1 - 2015/4

N2 - PurposeThe 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).MethodsA 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.ResultsFive 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; I2 = 0 %] and disability reduction (pooled SMD: −1.73, 95 % CI −2.09, −1.37; I2 = 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.ConclusionsAt 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.

AB - PurposeThe 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).MethodsA 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.ResultsFive 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; I2 = 0 %] and disability reduction (pooled SMD: −1.73, 95 % CI −2.09, −1.37; I2 = 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.ConclusionsAt 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.

KW - systematic review

KW - ertebral compression fracture

KW - conservative treatment

KW - analgesics

KW - orthoses

U2 - 10.1007/s00586-015-3821-5

DO - 10.1007/s00586-015-3821-5

M3 - Article

VL - 24

SP - 702

EP - 714

JO - European Spine Journal

JF - European Spine Journal

SN - 0940-6719

IS - 4

ER -