Department of Radiology, St. Elisabeth Ziekenhuis, Hilvarenbeekseweg 60, 5022GC, Tilburg, The Netherlands,
Skeletal Radiol. 2014 Jan;43(1):13-8. doi: 10.1007/s00256-013-1729-x. Epub 2013 Oct 8.
Little is known about the natural course of pain from vertebral compression fractures (VCF). In this study we evaluated the pain course in conservatively treated patients with back pain and a VCF on the spine radiograph.
Between May 2007 and November 2008, 169 patients with back pain referred by the general practitioner for spine radiographs and with a VCF were requested to participate in this follow-up study. Base line questionnaires about visual analogue scale (VAS) score, type of treatment and use of osteoporosis medication were filled in by 82 patients. Questionnaires were repeated at 6 weeks, and at 3, 6 and 12 months. Significant pain relief was defined as a decrease in VAS score of 50% or more from baseline.
At baseline, mean VAS score in 82 patients was 6.9 (SD 2.0). Significant pain relief at 12 months was reported by 44 patients (54%) while in 38 patients (46%) pain relief was insufficient. No predictors for pain relief could be identified. Patients with insufficient pain relief at 12 months used significantly more analgesics and in these patients physiotherapy did better than other types of therapy.
More than half of conservatively treated patients with back pain and VCF had sufficient pain relief at 12 months with most pain decrease in the first 3 months. However, a substantial proportion of patients still reported disabling pain. There were no predictors for the development of chronic pain. Patients with continuing pain ≥3 months after diagnosis of VCF may be candidates for vertebroplasty.
对于椎体压缩性骨折（VCF）引起的疼痛自然病程，人们知之甚少。本研究评估了经保守治疗后背痛且 X 线片显示 VCF 的患者的疼痛病程。
2007 年 5 月至 2008 年 11 月，我们向全科医生要求对脊椎 X 线片进行检查并怀疑有 VCF 的 169 例背痛患者提出参加本随访研究。82 例患者填写了基线时视觉模拟评分（VAS）、治疗类型和骨质疏松药物使用情况的问卷。6 周、3 个月、6 个月和 12 个月时重复问卷。VAS 评分从基线降低 50%或更多被定义为显著缓解。
82 例患者的基线 VAS 评分为 6.9（标准差 2.0）。12 个月时，44 例（54%）患者报告有显著缓解，而 38 例（46%）患者缓解不足。未确定缓解疼痛的预测因素。12 个月时疼痛缓解不足的患者使用的镇痛剂明显更多，在这些患者中，物理疗法的效果优于其他类型的治疗。
在保守治疗的背痛和 VCF 患者中，超过一半的患者在 12 个月时有足够的疼痛缓解，大多数疼痛在最初 3 个月内减轻。然而，仍有相当一部分患者报告有严重的疼痛。没有慢性疼痛发展的预测因素。在诊断 VCF 后持续疼痛≥3 个月的患者可能是椎体成形术的候选者。
