无急性椎体骨折的骨质疏松性腰痛的本质：每月一次阿仑膦酸水合物镇痛效果的前瞻性多中心研究。
The nature of osteoporotic low back pain without acute vertebral fracture: A prospective multicenter study on the analgesic effect of monthly minodronic acid hydrate.
作者信息
Fujimoto Kazuki, Inage Kazuhide, Orita Sumihisa, Yamashita Masaomi, Abe Koki, Yamagata Masatsune, Sainoh Takeshi, Akazawa Tsutomu, Kinoshita Tomoaki, Nemoto Tetsuharu, Hirayama Jiro, Murata Yasuaki, Kotani Toshiaki, Aoki Yasuchika, Eguchi Yawara, Sakuma Takeshi, Aihara Takahito, Ishikawa Tetsuhiro, Suseki Kaoru, Hanaoka Eiji, Yamauchi Kazuyo, Kubota Gou, Suzuki Miyako, Sato Jun, Shiga Yasuhiro, Kanamoto Hirohito, Inoue Masahiro, Kinoshita Hideyuki, Koda Masao, Furuya Takeo, Takahashi Kazuhisa, Ohtori Seiji
机构信息
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
出版信息
J Orthop Sci. 2017 Jul;22(4):613-617. doi: 10.1016/j.jos.2017.01.022. Epub 2017 Mar 9.
BACKGROUND
Patients with osteoporosis but no evidence of fracture can sometimes report low back pain. However, few studies have evaluated the nature of osteoporotic low back pain in a clinical situation. Therefore, the aim of this study was to examine the nature of osteoporotic low back pain without fracture, and the analgesic effect of minodronic acid hydrate on such pain.
METHODS
The current study examined 136 patients with osteoporotic low back pain and no lower extremity symptoms. The following factors were evaluated before and after minodronic acid hydrate administration: the nature of osteoporotic low back pain was evaluated using the painDETECT questionnaire, numeric rating scale (NRS) score for low back pain at rest and in motion, bone mineral density (BMD) of the lumbar spine, and the serum concentration of tartrate-resistant acid phosphatase 5b (TRACP-5b) as a bone metabolism marker.
RESULTS
A total of 113 patients were enrolled. The painDETECT questionnaire revealed the percentage of patients with nociceptive pain and neuropathic or mixed pain was approximately 85% and 15%, respectively. the average NRS scores for low back pain at rest decreased significantly 2 months after treatment (p = 0.01), while those in motion decreased significantly 1 month after treatment (p = 0.04). The average lumbar spine BMD tended to increase after treatment, but not significantly. On the other hand, the changes in the average serum concentration of TRACP-5b did significantly decrease 1 month after treatment. There was a significant positive correlation between the rate of NRS score improvement for low back pain at rest, and the rate of improvement in serum concentration of TRACP-5b (p < 0.05).
CONCLUSIONS
Osteoporotic low back pain consisted of 85% nociceptive pain and 15% neuropathic or mixed pain. The pain is strongly related to pain at rest rather than that in motion.
背景
骨质疏松症患者虽无骨折证据，但有时会出现腰痛。然而，很少有研究在临床情况下评估骨质疏松性腰痛的性质。因此，本研究的目的是检查无骨折的骨质疏松性腰痛的性质，以及米诺膦酸水合物对这种疼痛的镇痛效果。
方法
本研究检查了136例有骨质疏松性腰痛且无下肢症状的患者。在给予米诺膦酸水合物前后评估以下因素：使用疼痛检测问卷评估骨质疏松性腰痛的性质，静息和活动时腰痛的数字评分量表（NRS）评分，腰椎骨密度（BMD），以及作为骨代谢标志物的抗酒石酸酸性磷酸酶5b（TRACP-5b）的血清浓度。
结果
共纳入113例患者。疼痛检测问卷显示，伤害性疼痛患者以及神经性或混合性疼痛患者的百分比分别约为85%和15%。治疗2个月后，静息时腰痛的平均NRS评分显著降低（p = 0.01），而活动时的平均NRS评分在治疗1个月后显著降低（p = 0.04）。治疗后腰椎骨密度平均有增加趋势，但不显著。另一方面，治疗1个月后TRACP-5b的平均血清浓度变化确实显著降低。静息时腰痛的NRS评分改善率与TRACP-5b血清浓度改善率之间存在显著正相关（p < 0.05）。
结论
骨质疏松性腰痛由85%的伤害性疼痛和15%的神经性或混合性疼痛组成。这种疼痛与静息时的疼痛密切相关，而非活动时的疼痛。
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