Percutaneous Vertebroplasty for Painful Compression Fractures in a Small Cohort of Patients with a Decreased Expectation-Related Placebo Effect due to Dementia

• Published in: American journal of neuroradiology : AJNR 2008-09, Vol.29 (8), p.1461-1464
• Main Authors: Lehman, V.T, Gray, L.A, Kallmes, D.F
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cohort Studies; Comorbidity; Dementia - epidemiology; Female; Fractures, Compression; Fundamental and applied biological sciences. Psychology; Human; Humans; Investigative techniques, diagnostic techniques (general aspects); Learning; Learning. Memory; Male; Medical sciences; Minnesota - epidemiology; Nervous system; Pain - diagnosis; Pain - epidemiology; Pain Management; Placebo Effect; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Spinal Fractures; Spine; Stress, Psychological - epidemiology; Treatment Outcome; Vertebroplasty
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A1173

Although abundant literature has reported success with vertebroplasty for the treatment of painful compression fractures, none has accounted for a potential expectation-related placebo effect. We report the results of vertebroplasty for painful vertebral body compression fractures in a small cohort of patients with dementia with the assumption that this patient subgroup is subjected to a decreased placebo effect. All patients with objective evidence of dementia (N = 10) who had undergone vertebroplasty at our institution were identified from a comprehensive prospectively constructed vertebroplasty data base. The patients' pain at rest and activity, mobility, and pain-medication use were analyzed at 2 hours postprocedure, 1 week, 1 month, 6 months, and 1 year. Pain with activity decreased or resolved in 80%-100% of patients at each time point, whereas pain at rest decreased or resolved in 78%-100% of all patients at each time point. Improved mobility was reported in 80%-100% of patients at all time points. Pain medication was decreased or stopped in 67% of patients at 1 week and in 100% of patients at 6 months and 1 year. Treatment of painful compression fractures in patients with dementia demonstrates a high rate of success regarding pain relief and mobility. This study offers additional evidence that vertebroplasty has true benefit.