Antibiotic treatment in patients with chronic low back pain and vertebral bone edema [modic type I changes]: a randomized clinical controlled trial of efficacy

ABSTRACT

Modic type I changes/bone edema in the vertebrae are present in 6% of the general population and 35-40% of the low back pain population. It is strongly associated with low back pain. Chronic Low back pain [CLBP] is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. A new method of treatment included the use of antibiotic in management of CLBP with Modic type I changes has proved to be effective in some cases. The aim was to test the efficacy of antibiotic treatment in patients with chronic low back pain [>6 months] and Modic type I changes [bone edema]. The study was a randomized clinical trial [RCT] with 71 patients whose only known illness was chronic LBP of greater than 6 months duration occurring after a previous disc herniation and who also had bone edema demonstrated as Modic type I changes in the vertebrae adjacent to the previous herniation. Patients were randomized to either 100 days of antibiotic treatment or placebo and were evaluated at baseline, and end of treatment. Outcome measures: are the disease-specific disability Questionnaire, which is Roland Morris Disability Questionnaire [RMDQ] and lumbar pain. 43 of the 71 original patients were evaluated at baseline and at end of treatment follow-up. The two groups were similar at baseline. The antibiotic group had better improvement on the outcome measures and improvement continued after end of treatment. At baseline, 100 days follow-up the means of the disease specific disability-RMDQ changed antibiotic 15.5, 12; placebo 15, 14.8. For Lumbar pain antibiotics 6.4, 4.8; placebo 6.1, 6.0. The antibiotic protocol in this study was more effective for this group of patients [CLBP associated with Modic changes type I] than placebo in the outcomes: