scholarly journals Modic changes - An evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain

2020 ◽  
Vol 11 (5) ◽  
pp. 761-769
Author(s):  
Vibhu Krishnan Viswanathan ◽  
Ajoy Prasad Shetty ◽  
S. Rajasekaran
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Significance ◽  
Chronic Low Back Pain ◽  
Modic Changes ◽  
Narrative Review ◽  
Evidence Based ◽  
Low Back

scholarly journals The effect of infliximab in patients with chronic low back pain and Modic changes (the BackToBasic study): study protocol of a randomized, double blind, placebo-controlled, multicenter trial

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Elisabeth Gjefsen ◽  
Lars Christian Haugli Bråten ◽  
Guro Løvik Goll ◽  
Monica Wigemyr ◽  
Nils Bolstad ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Treatment Strategy ◽  
Treatment Options ◽  
Modic Changes ◽  
Low Back ◽  
Double Blind ◽  
Link Type

Abstract Background Low back pain is common and a significant number of patients experience chronic low back pain. Current treatment options offer small to moderate effects. Patients with vertebral bone marrow lesions visualized as Modic changes on magnetic resonance imaging may represent a subgroup within the low back pain population. There is evidence for inflammatory mediators being involved in development of Modic changes; hence, suppression of inflammation could be a treatment strategy for these patients. This study examines the effect of anti-inflammatory treatment with the TNF-α inhibitor infliximab in patients with chronic low back pain and Modic changes. Methods/design The BackToBasic trial is a multicenter, double blind, randomized controlled trial conducted at six hospitals in Norway, comparing intravenous infusions with infliximab with placebo. One hundred twenty-six patients aged 18–65 with chronic low back pain and type 1 Modic changes will be recruited from secondary care outpatients’ clinics. The primary outcome is back pain-specific disability at day 154 (5 months). The study is designed to detect a difference in change of 10 (SD 18) in the Oswestry Disability Index at day 154/ 5 months. The study also aims to refine MRI-assessment, investigate safety and cost-effectiveness and explore the underlying biological mechanisms of Modic changes. Discussion Finding treatments that target underlying mechanisms could pose new treatment options for patients with low back pain. Suppression of inflammation could be a treatment strategy for patients with low back pain and Modic changes. This paper presents the design of the BackToBasic study, where we will assess the effect of an anti-inflammatory treatment versus placebo in patients with chronic low back pain and type 1 Modic changes. The study is registered at ClinicalTrials.gov under the identifier NCT03704363. The EudraCT Number: 2017–004861-29.

scholarly journals Efficacy of zoledronic acid for chronic low back pain associated with Modic changes in magnetic resonance imaging

2014 ◽  
Vol 15 (1) ◽  
Author(s):  
Katri Koivisto ◽  
Eero Kyllönen ◽  
Marianne Haapea ◽  
Jaakko Niinimäki ◽  
Kaj Sundqvist ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Low Back Pain ◽  
Back Pain ◽  
Zoledronic Acid ◽  
Magnetic Resonance ◽  
Chronic Low Back Pain ◽  
Modic Changes ◽  
Low Back ◽  
Resonance Imaging

scholarly journals Effects of implementing evidence-based appropriateness guidelines for epidural steroid injection in chronic low back pain: the EAGER (Esi Appropriateness GuidElines pRotocol) study

2019 ◽  
Vol 8 (4) ◽  
pp. e000772
Author(s):  
Scott M Johnson ◽  
Troy Hutchins ◽  
Miriam Peckham ◽  
Yoshimi Anzai ◽  
Elizabeth Ryals ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Low Back Pain ◽  
Back Pain ◽  
Body Mass ◽  
Chronic Low Back Pain ◽  
Evidence Based ◽  
Low Back ◽  
Patient Level ◽  
Epidural Steroid ◽  
Evidence Based Guidelines

ObjectiveChronic low back pain is very common and often treated with epidural steroid injections (ESIs). As ESI referrals had been rapidly increasing at our Veterans’ Administration hospital, we were concerned that they were supplanting more comprehensive care. The objective was to determine how referral patterns and multidisciplinary care might change with the implementation of evidence-based guidelines.MethodsIn this retrospective observational study, multidisciplinary evidence-based guidelines were implemented in 2014 (EAGER: Esi Appropriateness GuidElines pRotocol) as part of the ordering process for an ESI. Time series analysis was performed to assess the primary outcome of subspecialty referral pattern, that is, the number of patients receiving referrals to ancillary services which might serve to provide a more comprehensive approach to their back pain. Secondary outcomes included patient-level changes (ie, body mass index, number of injections, opioid use), which were compared before and after protocol implementation.ResultsComparing preimplementation and postimplementation protocol periods, referrals to physical medicine/rehabilitation increased 11.7% (p=0.003) per year and integrative health increased 2.1% (p<0.001) per year among the 2294 individual patients who received ESI through the neurointerventional radiology service. Of 100 randomly selected patients for patient-level analysis, the median body mass index decreased from 31.57 to 30.22 (p=<0.001) and the mean number of injections decreased from 1.76 to 0.73 (p<0.001). The percentage of patients using oral opioid analgesics decreased from 72% to 49% (p=<0.001).ConclusionImplementation of evidence-based guidelines for ESI referral helps guide patients into a more comprehensive care pathway for chronic low back pain and is correlated with patient-level changes such as decreased body mass index and decreased opioid usage.

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