Osteoporotic thoracolumbar vertebral fractures are frequently accompanied by referred pain. Although percutaneous vertebroplasty (PVP) effectively alleviates local pain, its efficacy for referred pain remains limited. Pregabalin reduces neural sensitization and may enhance analgesic outcomes. This study aimed to investigate the effect of combining PVP with pregabalin on referred pain. In this retrospective cohort study, 108 patients were allocated to either a combination therapy group (PVP plus pregabalin, n = 55) or a PVP-alone group (n = 53). The Visual Analog Scale (VAS), Pain Sensitivity Questionnaire (PSQ), and Oswestry Disability Index (ODI) scores were assessed preoperatively and at 1 week, 1 month, 2 months, and 3 months postoperatively. The combination group demonstrated significantly lower VAS and PSQ scores at 1 week and 1 month postoperatively compared to the PVP-alone group (all P < 0.05). However, no significant differences were observed at 3 months. No significant intergroup differences were found in ODI scores throughout the follow-up period. Patients with high baseline VAS scores or high pain sensitivity (as indicated by PSQ) exhibited more pronounced early pain improvement in the combination group. The combination of PVP with pregabalin provides more effective relief of early postoperative referred pain, particularly in patients with high pain sensitivity. The baseline VAS score is a key predictor of early pain improvement. These findings suggest that postoperative analgesic strategies should be tailored to individual baseline pain sensitivity levels.