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Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty.
Brown DB, Gilula LA, Sehgal M, Shimony JS
(2004) AJR Am J Roentgenol 182: 319-22
MeSH Terms: Adult, Aged, Aged, 80 and over, Back Pain, Bone Cements, Chronic Disease, Cohort Studies, Female, Humans, Injections, Spinal, Lumbar Vertebrae, Male, Methylmethacrylate, Middle Aged, Recovery of Function, Retrospective Studies, Spinal Fractures, Thoracic Vertebrae, Time Factors, Treatment Outcome
Show Abstract · Added March 5, 2014
OBJECTIVE - Most fractures treated with percutaneous vertebroplasty are subacute and less than 1 year old. We report our experience treating chronic vertebral fractures with vertebroplasty.
MATERIALS AND METHODS - Our database identified 41 patients with symptomatic fractures more than 1 year old. These patients were categorized into subgroups determined by fracture age: 12 months 1 day-24 months (n = 16) or more than 24 months 1 day (n = 25). Changes in pain and mobility for the study group were compared with those in 49 patients with fractures less than 1 year old.
RESULTS - Thirty-three (80%) of the 41 patients in the study group had improvement in pain-seven (17%) had complete and 26 (63%) had partial relief. Forty-five (92%) of the 49 control group patients had improvement in pain-24 (49%) had complete and 21 (43%) had partial relief. The number of patients achieving partial or complete relief of pain was not statistically different between groups (p > 0.05), although complete relief was significantly more frequent in the control group (p = 0.002). Twenty patients (49%) in the study group versus 34 patients (69%) in the control group had improved mobility after vertebroplasty (p = 0.047). Patients with fractures 12 months 1 day-24 months old had improvement in mobility similar to that in patients in the control group (p = 0.962). Fractures more than 24 months 1 day old were associated with significantly less improvement in mobility (p = 0.006).
CONCLUSION - Most patients with fractures more than 1 year old will experience clinical benefit from vertebroplasty. Complete relief of pain is more likely when less mature fractures are treated.
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20 MeSH Terms
Sex hormone suppression by intrathecal opioids: a prospective study.
Roberts LJ, Finch PM, Pullan PT, Bhagat CI, Price LM
(2002) Clin J Pain 18: 144-8
MeSH Terms: Adult, Chronic Disease, Genitalia, Male, Gonadal Steroid Hormones, Humans, Hypothalamo-Hypophyseal System, Injections, Spinal, Libido, Male, Middle Aged, Narcotics, Pain, Prospective Studies, Testosterone
Show Abstract · Added December 10, 2013
OBJECTIVE - Sexual dysfunction and low testosterone levels have been observed previously in males with chronic noncancer pain treated with intrathecal opioids. To investigate the hypothesis that intrathecal opioids suppress the hypothalamic-pituitary-gonadal axis, a prospective nonrandomized investigation of the function of this axis was undertaken.
DESIGN - Ten males with chronic noncancer pain were evaluated for clinical and biochemical evidence of hypogonadism at baseline and during the first twelve weeks of intrathecal opioid therapy.
RESULTS - Intrathecal opioid administration resulted in a significant (p <0.0001) reduction in serum testosterone, from 7.7 +/- 1.1 (mean +/- SEM) nmol/L at baseline to 2.0 +/- 0.7, 2.8 +/- 0.5, and 4.0 +/- 0.9 nmol/L at 1, 4, and 12 weeks, respectively. This was associated with a reduction in libido and potency. Luteinizing hormone and follicle-stimulating hormone levels remained within reference ranges, indicating central rather than peripheral suppression.
CONCLUSIONS - Administration of intrathecal opioids may result in hypogonadotrophic hypogonadism. As part of the consent for therapy process, patients should be informed about this effect and its management. With long-term intrathecal opioid administration, the hypothalamic-pituitary-gonadal axis should be monitored. Where indicated, testosterone replacement should be undertaken to improve sexual function and prevent the potential metabolic effects of hypogonadism, in particular, osteoporosis.
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14 MeSH Terms
Outcome of intrathecal opioids in chronic non-cancer pain.
Roberts LJ, Finch PM, Goucke CR, Price LM
(2001) Eur J Pain 5: 353-61
MeSH Terms: Activities of Daily Living, Adult, Aged, Aged, 80 and over, Analgesics, Opioid, Chronic Disease, Drug Tolerance, Employment, Female, Follow-Up Studies, Humans, Infusion Pumps, Implantable, Injections, Spinal, Male, Middle Aged, Morphine, Pain, Patient Satisfaction, Retrospective Studies, Surveys and Questionnaires, Treatment Outcome
Show Abstract · Added December 10, 2013
Eighty-eight patients (58 women and 30 men; mean age 53.4 years) with chronic non-cancer pain present on average for 9.8 years were evaluated following treatment with intrathecal opioids for an average duration of 36.2 months. Outcome measures were global pain relief, physical activity levels, medication consumption, work status, intrathecal opioid side-effects, proportion of patients who ceased therapy and patient satisfaction. The most common diagnosis in this group was lumbar spinal or radicular pain after failed spinal surgery (n= 55, 63%). At the time of follow-up, mean pain relief was 60% with 74% of patients (36 of 49) reporting increased activity levels. Oral medication intake was significantly reduced (Medication Quantification Scale Score prior to implantation 31.0+/-2.6 and at follow-up 12.7+/-1.4; n= 48; p< 0.0001). These gains were not accompanied by a change in work status (43 of 50 working age patients not working at follow-up). There were frequent reports of opioid side-effects, including sexual dysfunction and menstrual disturbance. Technical complications occurred with the drug administration device, most often catheter related, requiring at least one further surgical procedure in 32 patients (40%). Patient satisfaction with intrathecal opioids was high, with 45 of 51 (88%) reporting satisfaction. Mean intrathecal morphine dose increased from 9.95+/-1.49 mg/day (mean+/-SEM) at 6 months to 15.26+/-2.52 mg/day 36 months after initiation of therapy. Drug administration systems were permanently removed in five patients (6%). Intrathecal opioid therapy appears to have a place in the management of chronic non-cancer pain. Therapy does not seem to be significantly inhibited by the development of tolerance.
Copyright 2001 European Federation of Chapters of the International Association for the Study of Pain.
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21 MeSH Terms
Hypogonadism in patients treated with intrathecal morphine.
Finch PM, Roberts LJ, Price L, Hadlow NC, Pullan PT
(2000) Clin J Pain 16: 251-4
MeSH Terms: Adult, Analgesics, Opioid, Chronic Disease, Estrogens, Female, Gonadotropins, Gonads, Humans, Hypogonadism, Hypothalamo-Hypophyseal System, Injections, Spinal, Libido, Male, Middle Aged, Morphine, Pain, Sex Characteristics, Testosterone
Show Abstract · Added December 10, 2013
OBJECTIVE - The objective of this study was to investigate the hypothalamic-pituitary-gonadal response to intrathecal opioids.
PATIENTS - Thirty patients receiving intrathecal morphine for chronic nonmalignant pain were studied for clinical and biochemical evidence of hypogonadism. Ten men and 10 postmenopausal women with chronic pain of similar duration but who were not receiving any form of opioid therapy acted as control subjects.
RESULTS - Men and both premenopausal and postmenopausal women had evidence of hypogonadism with low levels of serum testosterone or estrogen coupled with low levels of pituitary gonadotrophins. Control subjects had hormone levels in the expected range for their sex and age. Two men demonstrated recovery after ceasing intrathecal opioid therapy.
CONCLUSIONS - Hypogonadotrophic hypogonadism is a common complication of intrathecal opioid therapy in both men and women.
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18 MeSH Terms