Misleading history of pain location in 51 patients with osteoporotic vertebral fractures

Abstract

The aim of this study was to investigate associations between the location of osteoporotic vertebral fractures and the patient's localization of pain. Fifty-one consecutive patients (m 6, f 45; average age 74.8 years) with diagnosed osteoporotic vertebral fractures between T8 and L2 were included in the study. Exclusion criteria were fractures above T8 and below L2, spondylolisthesis, disc herniations, tumors, infections, and instability. Pain location was assessed by pain drawing, subdivided into thoracic, lumbar, and thoracic plus lumbar pain areas, and pain intensity using a 101 numeric rating scale. Furthermore, the onset of back pain and the lack or the indication of a trigger event at the onset of pain were documented. Only four of 20 patients with thoracic fractures reported thoracic pain, while the other 16 (80%) reported only lumbar pain. The location of the fracture and the patient's pain report were not related (Cohens Kappa=0.046; P=0.438). Patients with thoracic or lumbar osteoporotic fractures report pain mainly in the lumbosacrogluteal area. Therefore, the complaint of low back pain (LBP) in persons at risk for osteoporotic fractures may require both thoracic and lumbar X-rays. LBP patients with a suspect history of an osteoporotic vertebral fracture should also be given an X-ray of the thoracic and lumbar spine. Patients with a thoracic vertebral fracture had more severe pain than patients with a lumbar vertebral fracture. Onset not related to a fall or a false movement related to a significantly longer pain duration.