The purpose of this study is to determine whether pamidronate is effective and well-tolerated in the treatment of painful degenerative disk disease, also known as Modic type 1 changes
Erosive degenerative disk disease, also known as Modic type 1 changes, is usually characterized by low back pain, with an inflammatory pain pattern, as seen in spondylarthropathies. Intravenous pamidronate has proven effective in patients with ankylosing spondylitis, and in painful bone diseases in general. We therefore hypothesized that pamidronate would be effective in treating back pain associated with Modic type 1 changes. This study aimed to determine pamidronate's efficiency in reducing pain, with the primary outcome being a between-group difference of 30 points on a 100mm VAS at 3 months. Secondary outcomes are the improvement in functional status and the drug's tolerance. Primary and secondary outcome criteria will be assessed at each visit (inclusion, at 6 weeks, 3 months, and 6 months). If the primary goal is not attained, a rigid or semi-rigid back brace will be proposed to the patient, regardless of the treatment group. In total, 48 patients will need to be recruited. These patients will be randomly assigned to one of the two groups, with each group comprising 24 patients: one group will be given pamidronate and the other placebo. Pamidronate will be administered at a dose of 90mg per day, 2 days in a row, and every patient, regardless of the treatment group, will be given paracetamol, in order to maintain blinding by preventing drug-induced fever.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
48
CHU Clermont-Ferrand
Clermont-Ferrand, France
RECRUITINGback pain assessed on a100mm VAS
Time frame: at 3 months
- Functional status using EIFEL, Dallas, FABQ, MacTar, and MCII/PASS questionnaires
Time frame: at 6 weeks, 3 months, and 6 months
Back stiffness assessed by Schober's test and finger-to-floor distance
Time frame: at 6 weeks, 3 months, and 6 months
Inflammatory pain pattern
Inflammatory pain pattern: number of nightly awakenings, as well as duration and intensity of morning stiffness on a 100mm VAS
Time frame: at 6 weeks, 3 months, and 6 months
assess the efficacy of a rigid back brace in treating back pain
In case of failure to reduce the pain with pamidronate at 3 months: assess the efficacy of a rigid back brace in treating back pain
Time frame: at 6 weeks, 3 months, and 6 months
Tolerance based on the number and types of side-effects
Time frame: at 6 weeks, 3 months, and 6 months
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