[Influence of adjuvant pain medication on quality of life in the treatment of postmenopausal osteoporosis]

[Pain management in osteoporosis]

Osteoporosis is a very common disease all over the world, in which a reduction in bone density can lead to an increased risk of fractures and a diminished physical height. Osteoporosis is also associated with acute and chronic pain, which especially occurs in the back and can significantly reduce the quality of life. To provide sufficient care for affected patients, it is essential to know the particularities of pain management in osteoporosis, such as pharmacological and nonpharmacological treatment options. This article gives a comprehensive review of pain management in osteoporosis and also explains the underlying pathomechanisms, risk factors, and diagnostic procedures.

[Pain management in osteoporosis]

Osteoporosis is a very common disease all over the world, in which a reduction in bone density can lead to an increased risk of fractures and a diminished physical height. Osteoporosis is also associated with acute and chronic pain, which especially occurs in the back and can significantly reduce the quality of life. To provide sufficient care for affected patients, it is essential to know the particularities of pain management in osteoporosis, such as pharmacological and nonpharmacological treatment options. This article gives a comprehensive review of pain management in osteoporosis and also explains the underlying pathomechanisms, risk factors, and diagnostic procedures.

Management of chronic pain in osteoporosis: challenges and solutions

Osteoporosis (OP) is a pathological condition that manifests clinically as pain, fractures, and physical disability, resulting in the loss of independence and the need for long-term care. Chronic pain is a multidimensional experience with sensory, affective, and cognitive aspects. Age can affect each of these dimensions and the pain that is experienced. In OP, chronic pain appears to have sensory characteristics and properties of nociceptive and neuropathic pain. Its evaluation and treatment thus require a holistic approach that focuses on the specific characteristics of this population. Pain management must therefore include pharmacological approaches, physiotherapy interventions, educational measures, and, in rare cases, surgical treatment. Most rehabilitative treatments in the management of patients with OP do not evaluate pain or physical function, and there is no consensus on the effects of rehabilitation therapy on back pain or quality of life in women with OP. Pharmacological treatment of pain in patients with OP is usually insufficient. The management of chronic pain in patients with OP is complicated with regard to its diagnosis, the search for reversible secondary causes, the efficacy and duration of oral bisphosphonates, and the function of calcium and vitamin D. The aim of this review is to discuss the most appropriate solutions in the management of chronic pain in OP.

Vitamin D for the treatment of chronic painful conditions in adults

BACKGROUND

This review is an update of a previously published review in the Cochrane Database of Systematic Reviews (Issue 1, 2010) on 'Vitamin D for the treatment of chronic painful conditions in adults'.Vitamin D is produced in the skin after exposure to sunlight and can be obtained through food. Vitamin D deficiency has been linked with a range of conditions, including chronic pain. Observational and circumstantial evidence suggests that there may be a role for vitamin D deficiency in the aetiology of chronic painful conditions.

OBJECTIVES

To assess the efficacy and safety of vitamin D supplementation in chronic painful conditions when tested against placebo or against active comparators.

SEARCH METHODS

For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE to February 2015. This was supplemented by searching the reference lists of retrieved articles, reviews in the field, and online trial registries.

SELECTION CRITERIA

We included studies if they were randomised double-blind trials of vitamin D supplementation compared with placebo or with active comparators for the treatment of chronic painful conditions in adults.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected the studies for inclusion, assessed methodological quality, and extracted data. We did not undertake pooled analysis due to the heterogeneity of the data. Primary outcomes of interest were pain responder outcomes, and secondary outcomes were treatment group average pain outcomes and adverse events.

MAIN RESULTS

We included six new studies (517 participants) in this review update, bringing the total of included studies to 10 (811 participants). The studies were heterogeneous with regard to study quality, the chronic painful conditions that were investigated, the dose of vitamin D given, co-interventions, and the outcome measures reported. Only two studies reported responder pain outcomes; the other studies reported treatment group average outcomes only. Overall, there was no consistent pattern that vitamin D treatment was associated with greater efficacy than placebo in any chronic painful condition (low quality evidence). Adverse events and withdrawals were comparatively infrequent, with no consistent difference between vitamin D and placebo (good quality evidence).

AUTHORS' CONCLUSIONS

The evidence addressing the use of vitamin D for chronic pain now contains more than twice as many studies and participants than were included in the original version of this review. Based on this evidence, a large beneficial effect of vitamin D across different chronic painful conditions is unlikely. Whether vitamin D can have beneficial effects in specific chronic painful conditions needs further investigation.

Health related quality of life in male patients with osteoporosis: results of a cross sectional study

INTRODUCTION

Osteoporosis is one of the most common diseases affecting elderly persons. Male patients with osteoporosis have rarely been the focus of earlier studies. This study explores health related quality of life (HRQoL) indicators in a sample of German male patients with osteoporosis to determine potential avenues for clinical practice changes.

METHODS

This cross-sectional study describes two HRQoL indicators (EQ5D and QUALEFFO-41) in a sample of male patients being treated for osteoporosis. Questionnaires were sent to all male patients being treated at the Dresden University Hospital outpatient endocrine clinic. Of the 344 patients invited to participate in the study 155 (57.2%) were included.

RESULTS

Overall HRQoL EQ-5D-scores for male patients with osteoporosis were greater than those of comparable groups of the German population. Patients with ≥2 fractures had the highest level of impairment in HRQoL. Of all the dimensions of EQ-5D-scores, pain/discomfort was the most affected. Better HRQoL (median values <10.0/QUALEFFO-41 scores) were detected in the whole sample for jobs around the house, activities of daily living and mobility compared to other dimensions. The highest levels of impairment were observed in the QUALEFFO-41 domains of general health perception, mental function and pain.

CONCLUSION

This analysis confirms the association between number of fractures and worse estimation of HRQoL in male patients. Because men are 3 times less likely to suffer from osteoporosis than women, the specific HRQoL characteristics of male patients with this disease can often be overlooked. Clinicians should consider mental health referral especially for osteoporotic male patients having experienced ≥2 fractures.

Vitamin D for the treatment of chronic painful conditions in adults

BACKGROUND

Vitamin D is produced in the skin after sun-light exposure and can also be obtained through food. Vitamin D deficiency has recently been linked with a range of diseases including chronic pain. Observational and circumstantial evidence suggests that there may be a role for vitamin D deficiency in the aetiology of chronic pain conditions.

OBJECTIVES

To assess the efficacy and adverse events of vitamin D supplementation in chronic painful conditions.

SEARCH STRATEGY

We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to September 2009. This was supplemented by searching the reference lists of retrieved articles, textbooks and reviews.

SELECTION CRITERIA

Studies were included if they were randomised double blind trials of vitamin D supplementation compared with placebo or with active comparators for the treatment of chronic pain conditions in adults.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected the studies for inclusion, assessed methodological quality, and extracted data. Pooled analysis was not undertaken due to paucity and heterogeneity of data.

MAIN RESULTS

Four studies, with a total of 294 participants, were included. The studies were heterogeneous with regard to study quality, the chronic painful conditions that were investigated, and the outcome measures reported. Only one study reported a beneficial effect, the others found no benefit of vitamin D over placebo in treating chronic pain.

AUTHORS' CONCLUSIONS

The evidence base for the use of vitamin D for chronic pain in adults is poor at present. This is due to low quality and insufficient randomised controlled trials in this area of research.