Powered by the Evidence-based Practice Centers
Evidence Reports All of EHC
Evidence Reports All of EHC



Pain Management Interventions for Hip Fracture

Systematic Review ARCHIVED May 17, 2011
Download PDF files for this report here.

Page Contents

Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current.

People using assistive technology may not be able to fully access information in these files. For additional assistance, please contact us.

Structured Abstract


To review and synthesize the evidence on pain management interventions in nonpathological hip fracture patients following low-energy trauma. Outcomes include pain management (short and long term), mortality, functional status, pain medication use, mental status, health-related quality of life, quality of sleep, ability to participate in rehabilitation, return to pre-fracture living arrangements, health services utilization, and adverse effects.

Data Sources

Comprehensive literature searches were conducted in 25 electronic databases from 1990 to present. Searches of the grey literature, trial registries, and reference lists of previous systematic reviews and included studies were conducted to identify additional studies.


Study selection, quality assessment, data extraction, and grading of the evidence were conducted independently and in duplicate. Discrepancies were resolved by consensus or third-party adjudication. Meta-analyses were conducted where data were available and deemed appropriate.


In total, 83 studies were included (69 trials, 14 cohort studies). Most participants were females older than 75 with no cognitive impairment. The methodological quality of cohort studies was generally moderate; most trials were at high or unclear risk of bias. Included studies were grouped into eight intervention categories: systemic analgesia, anesthesia, complementary and alternative medicine, multimodal pain management, nerve blocks, neurostimulation, rehabilitation, and traction.

Most studies examined peri- and postoperative pain management, albeit from few perspectives such as reported pain, mortality, and adverse effects. Long-term pain was not reported, and other outcomes were reported infrequently. Nerve blockade was effective for relief of acute pain; however, most studies were limited to either assessing acute pain or use of additional analgesia and did not report on how nerve blockades may affect rehabilitation such as ambulation or mobility if the blockade has both sensory and motor effects. Acupressure, relaxation therapy, and transcutaneous electrical neurostimulation may be associated with potentially clinically meaningful reductions in pain, but further evidence is warranted before any firm conclusions are reached. While the strength of evidence is insufficient to make firm conclusions, postoperative physical therapy may improve pain control, andintravenous parecoxib, a systemic analgesic not available in North America, may be a possible alternative to traditional intramuscular injections of opiates and older nonsteroidal anti-inflammatory drugs (NSAIDs). Preoperative traction and spinal anesthesia (with or without additional agents) did not consistently reduce pain or complications in any demonstrable way compared with standard care. Although most studies reported on adverse effects, they were short term and not adequately powered to identify significant differences.

None of the included studies exclusively examined participants from institutional settings or with cognitive impairment, which reduces the generalizability of results to the overall hip fracture patient population.


For most interventions in this review there were sparse data available, which precludes firm conclusions for any single approach or for the optimal overall pain management following hip fracture.

Journal Publications

Abou-Setta AM, Beaupre LA, Rashiq S, et al. Comparative effectiveness of pain management interventions for hip fracture: a systematic review. Ann Intern Med 2011 May 16. [Epub ahead of print]

Project Timeline

Pain Management Interventions for Hip Fracture

Jan 1, 2005
Dec 9, 2009
May 17, 2011
Systematic Review Archived
May 17, 2011
May 17, 2011
Consumer Summary Archived
Aug 15, 2011
Consumer Summary Archived
Aug 20, 2013
Presentation Archived
Page last reviewed December 2019
Page originally created November 2017

Internet Citation: Systematic Review: Pain Management Interventions for Hip Fracture. Content last reviewed December 2019. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.

Select to copy citation