In both younger and older patients, vertebral fractures take weeks to heal with rest and pain relievers. Compression fractures of vertebrae associated with osteoporosis can also be treated with a procedure called vertebroplasty or kyphoplasty, which can help to reduce pain. In this procedure, a balloon is inflated in the compressed vertebra, often returning some of its lost height. Subsequently, a "cement" (methymethacrylate) is injected into the balloon and remains to retain the structure and height of the body of the vertebra. Pain is relieved as the height of the collapsed vertebra is restored.
Dr. Bjordal suggests that we graded evidence for acetaminophen too positively. In his letter, Dr. Bjordal describes one trial as evaluating acute low back pain when it actually evaluated chronic low back pain (9). Otherwise, our descriptions of the evidence are similar (Appendix Tables 10 and 11 (2)). We agree that our evidence ratings for acetaminophen were generous given some inconsistency among trials of acute low back pain, and lack of direct evidence and small benefits for chronic low back pain. We re-rated evidence for acetaminophen for acute low back pain fair quality with moderate benefits, and for chronic low back pain fair quality with small benefits (see Correction). Because of acetaminophen's favorable safety profile compared to other pharmacologic therapies, these changes do not change our recommendation to consider it as a first-line option for pharmacologic therapy (1).
The prognosis for pancreatitis depends on many different factors, such as the underlying condition causing pancreatitis, the severity of the pancreatitis, and the patient's age and underlying medical problems. Patients with pancreatitis can experience everything from a brief self-limited illness with a full recovery to severe course of illness that can lead to life-threatening complications and death. If an individual has repeated episodes of acute pancreatitis, they may develop chronic pancreatitis, a lifelong condition that can lead to a decreased quality of life.