Assessment, Quantification, and Management of Fracture Pain: from Animals to the Clinic
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Assessment, Quantification, and Management of Fracture Pain: from Animals to the Clinic Luke G. McVeigh 1 & Anthony J. Perugini 1 & Jill C. Fehrenbacher 2 & Fletcher A. White 3,4 & Melissa A. Kacena 1,4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Fractures are painful and disabling injuries that can occur due to trauma, especially when compounded with pathologic conditions, such as osteoporosis in older adults. It is well documented that acute pain management plays an integral role in the treatment of orthopedic patients. There is no current therapy available to completely control post-fracture pain that does not interfere with bone healing or have major adverse effects. In this review, we focus on recent advances in the understanding of pain behaviors post-fracture. Recent Findings We review animal models of bone fracture and the assays that have been developed to assess and quantify spontaneous and evoked pain behaviors, including the two most commonly used assays: dynamic weight bearing and von Frey testing to assess withdrawal from a cutaneous (hindpaw) stimulus. Additionally, we discuss the assessment and quantification of fracture pain in the clinical setting, including the use of numeric pain rating scales, satisfaction with pain relief, and other biopsychosocial factor measurements. We review how pain behaviors in animal models and clinical cases can change with the use of current pain management therapies. We conclude by discussing the use of pain behavioral analyses in assessing potential therapeutic treatment options for addressing acute and chronic fracture pain without compromising fracture healing. Summary There currently is a lack of effective treatment options for fracture pain that reliably relieve pain without potentially interfering with bone healing. Continued development and verification of reliable measurements of fracture pain in both preclinical and clinical settings is an essential aspect of continued research into novel analgesic treatments for fracture pain. Keywords Fracture pain . Nociceptive behaviors . Pain management . Animal fracture model . Opioids
Introduction Fractures are painful and disabling injuries that can occur at any age but are particularly prevalent in 40–50% of Luke G. McVeigh and Anthony J. Perugini contributed equally to this work. This article is part of the Topical Collection on Orthopedic Management of Fractures * Melissa A. Kacena [email protected] 1
Department of Orthopaedic Surgery, Indiana University School of Medicine, 1130 W. Michigan St, FH 115, Indianapolis, IN 46202, USA
2
Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA
3
Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, USA
4
Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
women and 13–22% of men with osteoporosis [1, 2]. The number of patients in the USA with osteoporosis or low bone density will continue to rise with the aging of the popul
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