Letter to editor - Identifying early risk factors for chronic pain development following vertebral fractures - single-center prospective cohort study

Sep 29, 2026

Letter to the Editor in Asian Spine Journal addresses an article on early predictors of chronic pain after vertebral fractures, emphasizing timely rehabilitation and long-term quality of life. It suggests strengthening future studies by adding radiological parameters, improving sample size planning for logistic regression to avoid underpowering, and integrating socioeconomic, comorbidity, and lifestyle factors to support a broader biopsychosocial model. It also notes potential limits in external validity due to a single-center design.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Letter to editor

Clinical significance and rationale

Suggested additions for future studies

Sample size and statistical power

Broader determinants for prediction

External validity and conclusion

Conflict of Interest

ORCID and author contributions

References

Letter to the Editor ASJ Asian Spine J. 2025;19(6): 1105-1106 [https://doi.org/10.31616/asj.2025.0611.r1](https://doi.org/10.31616/asj.2025.0611.r1)[ ](https://doi.org/10.31616/asj.2025.0611.r1)PISSN 1976-1902 • eISSN 1976-7846 Letter to editor: Identifying early risk factors for chronic pain development following vertebral fractures: a singlecenter prospective cohort study HinaVaish School of Health Sciences, Chhatrapati ShahuJi Maharaj University, Kanpur, India Received Sep 23, 2025; Accepted Oct 6, 2025 Corresponding author: Hina Vaish School of Health Sciences, Chhatrapati Shahu Ji Maharaj University, Kanpur, Uttar Pradesh, India Tel: +91-9450124758, E-mail: [hina22vaish@gmail.com](hina22vaish@gmail.com); [hinavaish@csjmu.ac.in](hinavaish@csjmu.ac.in) Dear Editor, We read with great interest the article titled “Identifying early risk factors for chronic pain development following vertebral fractures: a single-center prospective cohort study” published in the Asian Spine Journal [1]. The authors addressed a clinically significant issue, as vertebral fractures are a major source of morbidity, and early prediction of chronic pain is essential in guiding rehabilitation. By identifying high-risk individuals early, the study adds to well-timed interventions that may improve long-term quality of life. However, a few aspects could be strengthened in future studies. The inclusion of radiological parameters such as fracture morphology, the extent of vertebral collapse, sagittal alignment changes, and the presence of adjacent fractures would have provided valuable structural connects to the observed pain trajectories. Authors from previous research has shown that the mechanical and anatomical consequences of vertebral fractures can significantly influence both pain persistence and functional limitations [2,3] . A combined clinical–radiological model could therefore improve predictive accuracy. Next, no priori sample-size calculation was reported. Using conventional guidance for logistic regression, an events-per-variable (EPV) approach suggests that, a model with eight candidate predictors would require approximately 400 patients if the chronic pain incidence is 20%(EPV=10), and about more patients if a more conservative EPV=20 is applied. Without a formal sample-size calculation and given the observed number of events, the study may therefore be underpowered to detect smaller effects or interactions [4,5] . Authors from previous study recommended that observational studies that involve logistic regression in the analysis, a minimum sample size of 500 to derive statistics that can represent the parameters in the targeted population. The other recommended rules of thumb are EPV of 50 and formula; n=100+50i where i refers to number of independent variables in the final model [6] . Furthermore, although the study commendably examined psychological and functional variables, a more comprehensive approach could integrate socioeconomic indicators (educational level, occupational status, and economic status), comorbid conditions (osteoporosis, diabetes, cardiovascular disease), and lifestyle influences (physical activity, smoking, and nutrition) . These factors are increasingly recognized as important determinants of both pain perception and recovery tra- Copyright Ⓒ 2025 by Korean Society of Spine Surgery This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([http://creativecommons.org/licenses/by-nc/4.0/](http://creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Asian Spine Journal • pISSN 1976-1902 eISSN 1976-7846 • [www.asianspinejournal.org](www.asianspinejournal.org) jectories [7,8] . Their inclusion would have supported amore collective biopsychosocial model, well reflecting the complexity of chronic pain deve

FAQs

What is the main purpose of the letter to the editor?

To comment on an article about early risk factors for chronic pain after vertebral fractures and highlight why early prediction can guide rehabilitation.

Which radiological factors does the letter suggest including?

Fracture morphology, extent of vertebral collapse, sagittal alignment changes, and presence of adjacent fractures.

Why does the letter discuss sample size calculation?

It notes that no prior sample-size calculation was reported and that the study may be underpowered for smaller effects or interactions in logistic regression.

Sep 29, 2026

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