The Global Spine Care Initiative: a review of reviews and recommendations for the non-invasive management of acute osteoporotic vertebral compression fracture pain in low- and middle-income communities
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The purpose of this review was to develop recommendations for non-invasive management of pain due to osteoporotic vertebral compression fractures (OVCF) that could be applied in medically underserved areas and low- and middle-income countries.
We conducted a systematic review and best evidence synthesis of systematic reviews on the non-invasive management of OVCF. Eligible reviews were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Low risk of bias systematic reviews and high-quality primary studies that were identified in the reviews were used to develop recommendations.
From 6 low risk of bias systematic reviews and 14 high-quality primary studies we established that for acute pain management, in addition to rest and analgesic medication, orthoses may provide temporary pain relief, in addition to early mobilization. Calcitonin can be considered as a supplement to analgesics; however, cost is of concern. Once acute pain control is achieved, exercise can be effective for improving function and quality of life.
The findings from this study will help to inform the GSCI care pathway and model of care for use in medically underserved areas and low- and middle-income countries. Conservative management of acute pain and recovery of function in adults with OVCF should include early mobilization, exercise, spinal orthosis for pain relief, and calcitonin for analgesic-refractory acute pain.
KeywordsSpine Review literature as topic Fractures Compression Osteoporosis Early medical intervention Conservative treatment
Compliance with ethical standards
The Global Spine Care Initiative and this study were funded by grants from the Skoll Foundation and NCMIC Foundation. World Spine Care provided financial management for this project. The funders had no role in study design, analysis, or preparation of this paper.
Conflict of interest
AA declares no COI. KR declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. HY declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. PC declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care; Canadian Institutes of Health Research Canada. Research Chair Ontario Ministry of Finance; Financial Services Commission of Ontario; Ontario Trillium Foundation, ELIB Mitac; Fond de Recherche and Sante du Quebec. SH declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care; Clinical Policy Advisory Board and stock holder, Palladian Health; Advisory Board, SpineHealth.com; Book Royalties, McGraw Hill; Travel expense reimbursement—CMCC Board. RC declares funding from AHRQ to conduct systematic reviews on treatments for low back pain within last 2 years. Honoraria for speaking at numerous meetings of professional societies and non-profit groups on topics related to low back pain (no industry sponsored talks). EH declares he is a consultant for: RAND Corporation; EBSCO Information Services; Southern California University of Health Sciences; Western University of Health Sciences Data and Safety Monitoring Committee; Chair, Palmer Center for Chiropractic Research; Research Committee Co-chair, World Spine Care. MN declares funding from Skoll Foundation and NCMIC Foundation through World Spine Care; Co-Chair, World Spine Care Research Committee; Palladian Health, Clinical Policy Advisory Board member; Book Royalties Wolters Kluwer and Springer; Honoraria for speaking at research method courses. JJW declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. HR declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. ATV declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care.
- 1.American Association of Neurological Surgeons (2016) Vertebral compression fractures. http://www.aans.org/patient%20information/conditions%20and%20treatments/vertebral%20compression%20fractures.aspx. Accessed 1 Dec 2016
- 2.Denis F (1984) Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res (189):65–76Google Scholar
- 6.World Health Organization (2007) WHO scientific group on the assessment of osteoporosis at primary health care level. http://www.who.int/chp/topics/Osteoporosis.pdf. Accessed 27 Jan 2017
- 8.Felsenberg D, Silman AJ, Lunt M, Armbrecht G, Ismail AA, Finn JD, Cockerill WC, Banzer D, Benevolenskaya LI, Bhalla A, Bruges Armas J, Cannata JB, Cooper C, Dequeker J, Eastell R, Felsch B, Gowin W, Havelka S, Hoszowski K, Jajic I, Janott J, Johnell O, Kanis JA, Kragl G, Lopes Vaz A, Lorenc R, Lyritis G, Masaryk P, Matthis C, Miazgowski T, Parisi G, Pols HA, Poor G, Raspe HH, Reid DM, Reisinger W, Schedit-Nave C, Stepan JJ, Todd CJ, Weber K, Woolf AD, Yershova OB, Reeve J, O’Neill TW (2002) Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 17:716–724. https://doi.org/10.1359/jbmr.2002.17.4.716 CrossRefPubMedGoogle Scholar
- 15.Knopp-Sihota JA, Newburn-Cook CV, Homik J, Cummings GG, Voaklander D (2012) Calcitonin for treating acute and chronic pain of recent and remote osteoporotic vertebral compression fractures: a systematic review and meta-analysis. Osteoporos Int 23:17–38. https://doi.org/10.1007/s00198-011-1676-0 CrossRefPubMedGoogle Scholar
- 21.Chen LX, Li YL, Ning GZ, Li Y, Wu QL, Guo JX, Shi HY, Wang XB, Zhou Y, Feng SQ (2015) Comparative efficacy and tolerability of three treatments in old people with osteoporotic vertebral compression fracture: a network meta-analysis and systematic review. PLoS One 10:e0123153. https://doi.org/10.1371/journal.pone.0123153 CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 7:10. https://doi.org/10.1186/1471-2288-7-10 CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Chou R, Hashimoto R, Friedly J, Fu R, Dana T, Sullivan S, Bougatsos C, Jarvik J (2015) AHRQ Technology assessments. In: Pain management injection therapies for low back Pain. Agency for Healthcare Research and Quality (US), Rockville (MD)Google Scholar
- 30.National Institute for Health and Care Excellence (NICE) (2012) The guidelines manual. https://www.nice.org.uk/article/pmg6/chapter/1%20introduction#ftn.footnote_1. Accessed 16 May 2016
- 31.de Kam D, Smulders E, Weerdesteyn V, Smits-Engelsman BC (2009) Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials. Osteoporos Int 20:2111–2125. https://doi.org/10.1007/s00198-009-0938-6 CrossRefPubMedGoogle Scholar
- 34.Anonymous (2000) Osteoporosis prevention, diagnosis, and therapy. NIH Consens Statement 17:1–45Google Scholar
- 36.Coggins ME (1995) Nonunions and malunions of thoracolumbar spine injuries. Semin Spine Surg 7:137–140Google Scholar
- 37.Consoli V, Alfieri P, Giuntini C, Mancia M, Avaldi F, Soncini R (1991) A double blind placebo-controlled trial of the efficacy and tolerability of intranasal elcatonin administered to patients suffering from senile and postmenopausal osteoporosis. Curr Ther Res 50:369–378Google Scholar
- 39.Zhang THD, YH, Yu SM, Zhnag C, Ya B (2013) Analgesics osteoporotic fracture healing. J Clin Rehabil Tissue Eng Res 17:6364-6374Google Scholar
- 40.World Health Organization WHO’s cancer pain ladder for adults. http://www.who.int/cancer/palliative/painladder/en/. Accessed 5 Feb 2017
- 43.Lyritis GP, Ioannidis GV, Karachalios T, Roidis N, Kataxaki E, Papaioannou N, Kaloudis J, Galanos A (1999) Analgesic effect of salmon calcitonin suppositories in patients with acute pain due to recent osteoporotic vertebral crush fractures: a prospective double-blind, randomized, placebo-controlled clinical study. Clin J Pain 15:284–289CrossRefGoogle Scholar
- 44.Pontiroli AE, Pajetta E, Scaglia L, Rubinacci A, Resmini G, Arrigoni M, Pozza G (1994) Analgesic effect of intranasal and intramuscular salmon calcitonin in post-menopausal osteoporosis: a double-blind, double-placebo study. Aging (Milan, Italy) 6:459–463Google Scholar
- 45.Flynn JA, Choi MJ, Wooster LD (2013) Oxford American handbook of clinical medicine. Oxford University Press, New YorkGoogle Scholar
- 48.Bergland A, Thorsen H, Karesen R (2011) Effect of exercise on mobility, balance, and health-related quality of life in osteoporotic women with a history of vertebral fracture: a randomized, controlled trial. Osteoporos Int 22:1863–1871. https://doi.org/10.1007/s00198-010-1435-7 CrossRefPubMedGoogle Scholar
- 50.Papaioannou A, Adachi JD, Winegard K, Ferko N, Parkinson W, Cook RJ, Webber C, McCartney N (2003) Efficacy of home-based exercise for improving quality of life among elderly women with symptomatic osteoporosis-related vertebral fractures. Osteoporos Int 14:677–682. https://doi.org/10.1007/s00198-003-1423-2 CrossRefPubMedGoogle Scholar
- 51.Yang LH, Cheng-qi H, Lei Z, Xie W, Lan Q (2007) Effect of pain-free exercises on female osteoporosis patients with spinal compressive fracture. J Clin Rehabil Tissue Eng Res 11:9108–9111Google Scholar
- 52.Pfeifer M, Kohlwey L, Begerow B, Minne HW (2011) Effects of two newly developed spinal orthoses on trunk muscle strength, posture, and quality-of-life in women with postmenopausal osteoporosis: a randomized trial. Am J Phys Med Rehabil 90:805–815. https://doi.org/10.1097/PHM.0b013e31821f6df3 CrossRefPubMedGoogle Scholar
- 54.Bennell KL, Matthews B, Greig A, Briggs A, Kelly A, Sherburn M, Larsen J, Wark J (2010) Effects of an exercise and manual therapy program on physical impairments, function and quality-of-life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial. BMC Musculoskelet Disord 11:36. https://doi.org/10.1186/1471-2474-11-36 CrossRefPubMedPubMedCentralGoogle Scholar
- 55.Gold DT, Shipp KM, Pieper CF, Duncan PW, Martinez S, Lyles KW (2004) Group treatment improves trunk strength and psychological status in older women with vertebral fractures: results of a randomized, clinical trial. J Am Geriatr Soc 52:1471–1478. https://doi.org/10.1111/j.1532-5415.2004.52409.x CrossRefPubMedGoogle Scholar
- 56.World Health Organization (2012) Scoping document for WHO guidelines for the pharmacological treatment of persisting pain in adults with medical illnesses. In: Pain TGo (ed). http://www.who.int/medicines/areas/quality_safety/Scoping_WHO_GLs_PersistPainAdults_webversion.pdf?ua=1. Accessed 5 Feb 2017
- 57.Morrison A, Polisena J, Husereau D, Moulton K, Clark M, Fiander M, Mierzwinski-Urban M, Clifford T, Hutton B, Rabb D (2012) The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. Int J Technol Assess Health Care 28:138–144. https://doi.org/10.1017/s0266462312000086 CrossRefPubMedGoogle Scholar