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Pain and Spine Medicine

Intra-Nasal Calcitonin for Subacute Lumbar Back Pain Secondary to Non-Operative Burst Fracture: A Case Report

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 4

    Co-Author(s)

  • Jonathan Paul, MD

    Resident Physician
    University of Miami/Jackson Health System PM&R Program
    Miami, Florida

    • Poster Presenter(s)

  • Dustin Yeung, BA

    Medical Student
    Tulane University School of Medicine
    New Orleans, Louisiana

    • Co-Author(s)

  • JV

    Jose Vives Alvarado, MD

    Attending Physician
    University of Miami
    Guaynabo, PR

Disclosure(s):
Dustin Yeung, Other: No financial relationships to disclose
Case Diagnosis: 58 year-old male presents to acute inpatient rehab with uncontrolled pain secondary to a non-operative lumbar burst fracture, successfully managed with intra-nasal calcitonin.

Case Description or Program Description: The patient initially presented with uncontrolled back pain secondary to lumbar burst fracture that was deemed non-operative. He failed conventional pain management with tylenol, opioids, topicals and neuropathic pain agents. Intra-nasal calcitonin was introduced as an adjunctive agent and the patient’s average pain score decreased allowing successful weaning and discontinuation of opioid medications by the time of discharge.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: The patient initially presented with uncontrolled back pain secondary to lumbar burst fracture that was deemed non-operative. He failed conventional pain management with Tylenol, opioids, topical and neuropathic pain agents. Intra-nasal calcitonin was introduced as an adjunctive agent and the patient’s average pain score decreased allowing successful weaning and discontinuation of opioid medications by the time of discharge.

Discussion (relevance): his case highlights a potential novel approach in subacute pain management for non-operative traumatic burst fractures. Intra-nasal calcitonin has been purported to relieve pain in osteoperotic compression fractures, however rarely described in literature for traumatic burst fractures. While the mechanism of calcitonin for pain relief is not well established, it is theorized that it may decrease pain in a multifactorial approach which involves increased endorphins, inhibition of neuro-inflammation, and dopamine modulation in the central nervous system. The typical length of treatment ranges between 4-8 weeks depending on the mechanism of fracture. It is important to note that with the addition of calcitonin allowed the patient to participate and tolerate the remainder of his intensive therapy.

Conclusions: Intra-nasal calcitonin may be a viable option for adjunctive pain control in the acute rehabilitation setting for patients with stable non-operative burst fractures.