Pharmacologic Pain Management

Women with new vertebral fractures have an increased risk of back pain and functional limitation because of back pain.²⁰ Back pain due to vertebral collapse is one of the main symptoms of postmenopausal osteoporosis. Vertebral deformity is the classical hallmark of osteoporosis. Three types of vertebral deformity are usually described: crush, wedge and biconcave deformities. The aim of a recent study²¹ was to compare the epidemiological characteristics of the three types of vertebral deformity and to explore the relationships of the number and type of deformity with back pain and height loss. In this study, all types of deformity were associated with height loss, which was greatest for individuals with crush deformity. Back pain was also associated with all types of deformity.

Pain associated with hip fractures is also commonplace and debilitating, adding to the substantial morbidity in the immediate post-hip fracture period and post surgical repair of hip fracture. Since hip fractures commonly occur in older, frail adults, presence or absence of cognitive impairment plays a major role in the provision of analgesics prescribed and administered as documented in a recent study.²²

Although, there are no specific guidelines addressing the management of osteoporotic pain in older adults, the general principles for management of chronic, non-malignant pain in older adults are applicable. The following sections briefly describe the World Health Organization (WHO) three-step ladder for cancer pain, and the American Geriatrics Society Guidelines for the Management of Chronic Pain in Older Persons. A brief description of selected analgesics follows.

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