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.
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