Back Pain-Inducing Test, a Novel and Sensitive Screening Test for Painful Osteoporotic Vertebral Fractures: A Prospective Clinical Study

Abstract

To detect painful vertebral fractures (VFs) in back pain populations at risk of osteoporosis, we designed a physical examination test (the Back Pain‐Inducing Test [BPIT]) that included three movements: lying supine, rolling over, and sitting up. If back pain is induced during any of these movements, the result is defined as positive, thereby establishing a presumptive diagnosis of painful VFs. Pain severity is quantified using a self‐reported numerical rating scale (NRS). The presence or absence of painful VFs is verified by whole‐spine magnetic resonance imaging (MRI), the gold standard for final diagnosis. According to the standards for reporting diagnostic accuracy, a real‐world, prospective, and observational study was performed on 510 back pain patients (enrolled from a single institute) at risk of osteoporosis. The sensitivity, specificity, and accuracy of the BPIT for identifying painful VFs were 99.1% (95% CI, 97.5% to 99.8%), 67.9% (95% CI, 60.4% to 74.5%), and 89.0%, respectively. The positive and negative predictive values were 86.6% (95% CI, 82.9% to 89.6%) and 97.4% (95% CI, 92.6% to 99.3%), respectively. Cutoff NRS scores for lying supine, rolling over, and sitting up were 3, 0, and 2, respectively. The corresponding area under the receiver operating characteristic curves (AUROCs) of each movement was 0.898 (95% CI, 0.868 to 0.922), 0.884 (95% CI, 0.854 to 0.911), and 0.910 (95% CI, 0.882 to 0.933), respectively. Although the high prevalence of VFs in the enrolled cohort partially limits the external validity of the predictive value in the general population, we conclude that the BPIT is potentially effective for detecting painful VFs in back pain populations at risk of osteoporosis. This test may be used as a stratification tool in decision‐making on subsequent imaging procedures: a negative BPIT rules out painful VFs and indicates that an MRI should be spared, whereas a positive BPIT means that an MRI is necessary and is likely to identify painful VFs. © 2019 American Society for Bone and Mineral Research.

Clinical Profiles of Osteoporotic Vertebral Compression Fractures: A Secondary Data Analysis of 358 Patients from a Prospective Clinical Study

“…The clinical pro les of the 358 patients enrolled in the study are shown in Table 1. The clinical pro les of OVFs are outlined as follows: (i) the most prevalent back pain site was localized in the thoracic-lumbar junction and lower (70.7%); unilateral back pain (49/358, 13.7%) and lumbosacral or buttock pain remote from the site of the lesion (14/358, 3.9%) was possible; (ii) the prevalence of the incident RP, SPT, and ASPP was 21.2%, 55.0%, and 23.2%, respectively; (iii) half of patients (51.1%) sought medical attention within two weeks of the onset of back pain, 16.5% of patients had delayed medical attention, and patients with a history of VF or VA did not seek medical aid at the rst point of the onset of back pain; (iv) 53.6% of patients had a spontaneous VF, and the precipitating events included falling from a standing height or less, coughing, sneezing, and routine everyday activity (lifting, bending, walking, and position changes); (v) the patient presented for care with a complaint, usually acute pain resulting in disability or di culty lying supine or sitting up from a supine position, such pain is elicited and refractory once the stress or loading on the axial spine changes and will subsides (even disappears) while the trunk is static; and (vi) the most frequent areas for VFs were the rst and second lumbar vertebrae (L1 and L2) and twelfth thoracic vertebra (T12) [12]. patients with radiating chest pain complained that the RP was more severe than the back pain.…”

“…They were blinded to the clinical information and established the presence of a VF according to the following diagnostic criteria: low signal changes on T1-weighted images (T1WI) and high or low signal changes on T2-weighted images (T2WI), particularly high signal changes on short-tau inversion recovery (STIR) images [15][16][17]. The interrater consistency for interpreting MRI was perfect [12].…”

“…In the outpatient setting, back pain is among the prevalent complaints for patients with OVFs, such pain may result from one single factor (structural factor) or several originators [10,11], even be in common with other pain-related clinical features, such as radiating pain (RP) and referred pain, among others [11][12][13]. An extensive review of literature showed that the quoted clinical features were proposed based on clinical impression rather than proper clinical study.…”

“…Our prior study demonstrated that the Back Pain-Inducing Test (BPIT) is a sensitive approach to screen patients with painful OVFs [12], indicating that back pain from OVFs is speci c. The discrepancy between the actual location of the OVF and the location suggested by RP, spinal palpation tenderness (SPT), or axial spinal percussion pain (ASPP) has been con rmed [13]. Our previous study also hinted that RP, SPT, and ASPP were not present in all patients, but approaches to characterize these incident measures in patients are underinvestigated.…”

Pain and Stress Detection Using Wearable Sensors and Devices—A Review

“…For this reason existing paininducing tests (e.g., hot plate test, tail flick test, etc.) solely use animals as experimental subjects or focus on the relation between a pre-existing pain condition with some specific movement (e.g., back pain-inducing test [2] examines the pain condition during movements of lying supine, rolling over, and sitting up). The challenge of designing a proper pain-inducing test leads to the second difficulty, which is that pain detection is thus limited in the medical field or clinical aspects.…”