Managing pain in Osteoporotic Spine Fractures Bijan Nejad Consultant in Pain Medicine and Anaesthesia

Affects up to 25% people over 70 years and 50% over 80 Years with one year mortality of 15% and 2- year mortality of 20% . Associated compromised pulmonary function. Normal quality but decreased in quantity. It causes compression type spine fracture. Wedge fracture is a subtype, when part of the vertebra usually the anterior part collapses under pressure.

Osteoporotic vertebral fractures are associated with considerable reduction of quality of life, morbidity, and mortality. The management of patients with vertebral fractures should include treatment for osteoporosis and measures to reduce pain and improve mobility Spinal compression fracture and pain can produce an imbalance between the use of back extensors (the major trunk supportive muscles) and flexors. To decrease painful contractions of the erector spinae muscles, one needs to decrease the load over the anterior aspect of the spinal column and vertebral bodies.

Clinical or subclinical vertebral fractures are a common cause of back pain. Vertebral fractures cause acute pain in the back in the acute phase of the fracture and chronic pain resulting from the associated skeletal deformity, joint damage, and tension on muscles and tendons, leading to disability.

What type of pain? Neuropathic pain: Pain that arises as a direct consequence of a lesion or disease affecting the somatosensory system ( shooting ,burning, altered sensation) Or Mechanical pain caused by e.g. Facet joint , Disc , Vertebral fracture, SIJ, Myofascial pain.

Presentation: Thoracic spine is most affected Spine fractures do not always involve pain The symptoms and severity vary based on what type of fracture and also depending on weather is it causing nerve irritation.

Pain Management Simple analgesics Opioids Neuropathic medications Sleep hygiene Trigger point injection Facet joint injection Nerve blocks