Lack of effectiveness of antibiotics in chronic low back pain with Modic 1 changes

Palazzo, Clémence; Ferrari, Maeva; Lefèvre-Colau, Marie-Martine; Nguyen, Christelle; Rannou, François; Poiraudeau, Serge

doi:10.1016/j.jbspin.2016.08.001

Cited by 23 publications

(13 citation statements)

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“…Recently, the role of local inflammation has been challenged by the results of a randomized, placebo-controlled trial of 162 patients with chronic LBP associated with active discopathy, showing that treatment with antibiotics (amoxicillin-clavulanic acid for 100 days) was effective at 100 days and at 1 year (33). These findings suggested that local low-grade infection could occur in patients with active discopathy (33), but this hypothesis remains controversial (34). In the absence of antibiotic prophylaxis, we did not observe MRI findings consistent with infectious spondylodiscitis occurring at the level of the IDI at 12 months.…”

Section: Original Researchcontrasting

confidence: 61%

Intradiscal Glucocorticoid Injection for Patients With Chronic Low Back Pain Associated With Active Discopathy

et al. 2017

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Section: Original Researchcontrasting

confidence: 61%

Intradiscal Glucocorticoid Injection for Patients With Chronic Low Back Pain Associated With Active Discopathy

et al. 2017

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“…Low-grade discitis might be a complication of disc surgery due to introduction of bacteria into the disc during the surgical procedure. The randomised trial from 2013 with a high number of patients with previous surgery found effect of antibiotic treatment [4], while a case series with few patients with previous surgery was negative [14].…”

Section: Previous Disc Surgery At Level With Modic Changesmentioning

confidence: 99%

Clinical effect modifiers of antibiotic treatment in patients with chronic low back pain and Modic changes - secondary analyses of a randomised, placebo-controlled trial (the AIM study)

Bråten

Grøvle

Espeland

et al. 2020

BMC Musculoskelet Disord

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Background: Randomised trials on antibiotic treatment for patients with chronic low back pain and vertebral endplate changes visible on MRI (Modic changes) have shown mixed results. A possible explanation might be a real treatment effect in subgroups of the study populations. The purpose of the present study was to explore potential clinical effect modifiers of 3-months oral amoxicillin treatment in patients with chronic low back pain and type I or II Modic changes at the level of a previous lumbar disc herniation. Methods: We performed analyses of effect modifiers on data from AIM, a double-blind parallel-group multicentre trial. One hundred eighty patients with chronic low back pain, previous disc herniation, Modic change type I (n = 118) or type II (n = 62) were randomised to 3-months oral treatment with 750 mg amoxicillin (n = 89) or placebo (n = 91) three times daily. The primary outcome was the Roland-Morris Disability Questionnaire (RMDQ) score (possible values 0-24) at 1-year follow-up in the intention-to-treat population. The predefined minimal clinically important between-group mean difference was 4 RMDQ points (not reached in the primary analysis of AIM). Predefined baseline characteristics were analysed as potential effect modifiers, four primary (type I Modic changes, previous disc surgery, positive pain provocation test, high CRP) and five exploratory (disturbed sleep, constant low back pain, short duration of low back pain, younger age, and male) using ANCOVA with interaction terms.

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“…Oral antibiotics significantly improved LBP symptoms and decreased MC size . However, a recent study failed to replicate these results, and side effects may limit usage. Intravenous bisphosphonates, such as zoledronic acid (ZA) and pamidronate, have shown analgesic effects on LBP .…”

Section: Introductionmentioning

confidence: 95%

Effect of Zoledronic Acid and Denosumab in Patients With Low Back Pain and Modic Change: A Proof-of-Principle Trial

Cai

Laslett

Aitken

et al. 2018

Journal of Bone and Mineral Research

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The aim of this study was to evaluate the effect of zoledronic acid (ZA) and denosumab on low back pain (LBP) and Modic change (MC) over 6 months. Adults aged ≥40 years with significant LBP for at least 6 months duration and MC (type 1, 2, or mixed) were randomized to receive ZA (5 mg/100 mL), denosumab (60 mg), or placebo. LBP was measured monthly by visual analogue scale (VAS) and the LBP Rating Scale (RS). MC was measured from MRIs of T -S vertebrae at screening and 6 months. A total of 103 participants with moderate/severe LBP (mean VAS = 57 mm; mean RS = 18) and median total MC area 538 mm were enrolled. Compared to placebo, LBP reduced significantly at 6 months in the ZA group for RS (-3.3; 95% CI, -5.9 to -0.7) but not VAS (-8.2; 95% CI, -18.8 to +2.4) with similar findings for denosumab (RS, -3.0; 95% CI, -5.7 to -0.3; VAS, -10.7; 95% CI, -21.7 to +0.2). There was little change in areal MC size overall and no difference between groups with the exception of denosumab in those with type 1 Modic change (-22.1 mm ; 95% CI, -41.5 to -2.7). In post hoc analyses, both medications significantly reduced VAS LBP in participants with milder disc degeneration and non-neuropathic pain, and denosumab reduced VAS LBP in those with type 1 MC over 6 months, compared to placebo. Adverse events were more frequent in the ZA group. These results suggests a potential therapeutic role for ZA and denosumab in MC-associated LBP. © 2018 American Society for Bone and Mineral Research.

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Lack of effectiveness of antibiotics in chronic low back pain with Modic 1 changes

Cited by 23 publications

References 10 publications

Intradiscal Glucocorticoid Injection for Patients With Chronic Low Back Pain Associated With Active Discopathy

Intradiscal Glucocorticoid Injection for Patients With Chronic Low Back Pain Associated With Active Discopathy

Clinical effect modifiers of antibiotic treatment in patients with chronic low back pain and Modic changes - secondary analyses of a randomised, placebo-controlled trial (the AIM study)

Effect of Zoledronic Acid and Denosumab in Patients With Low Back Pain and Modic Change: A Proof-of-Principle Trial

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