Department of Radiology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, Tilburg, NL 5022 GC, The Netherlands.
J Vasc Interv Radiol. 2010 Sep;21(9):1405-9. doi: 10.1016/j.jvir.2010.05.018.
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.
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.
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.
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.
作者前瞻性地确定了保守治疗急性骨质疏松性椎体压缩性骨折（VCF）患者疼痛的自然病程。此外，还评估了这些患者接受的保守治疗类型。
年龄大于 50 岁、因急性背痛接受脊柱 X 线检查的患者被要求完成基线临床问卷。对急性 VCF 患者进行 6 个月和 23 个月的随访，采用问卷包括视觉模拟评分（VAS）和疼痛药物类型及其他保守治疗。显著疼痛缓解定义为 VAS 降低 50%或更多。
49 例（平均年龄 78 岁；范围 51-95 岁）急性 VCF 患者随访近 2 年。35 例患者中有 22 例（63%）在 6 个月时、36 例中有 25 例（69%）在 23 个月时出现显著疼痛缓解。在 23 个月时仍有持续疼痛的患者（平均 VAS 6.4），6 个月时 VAS 有一定程度下降，但在 6-23 个月期间没有下降。未发现显著疼痛缓解的预测因素。疼痛缓解显著的患者使用的疼痛药物较少，物理治疗也较少。
在大多数急性 VCF 患者中，疼痛会随着保守治疗而显著减轻，主要发生在最初的 6 个月内。然而，在急性 VCF 后近 2 年，仍有三分之一的患者疼痛严重，需要大多数患者使用止痛药和物理治疗。未发现从急性转为慢性疼痛的预测因素。
