Efficiency and Safety Study of Pamidronate in Inflammatory Back Pain Due to Degenerative Disk Disease

Study Overview
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Brief Summary
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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

Detailed Description
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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.

Conditions
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Intervertebral Disc Degeneration, Modic I Discopathy, Back Pain, Low Back Pain, Magnetic Resonance Imaging (MRI)

Intervention / Treatment
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* Drug: Pamidronate
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Age from 18 to 60 years old Low back pain Daily pain since at least 3 months VAS for pain > 40/100 during the last 48 hours Inefficiency, intolerance, or contraindication to NSAIDS Inefficiency of a rigid or half-rigid back brace Modic 1 discopathy (diagnosed on MRI and confirmed by trained radiologist) Dental check-up within the last 6 months Signed informed consent Exclusion Criteria: - Static disorders of the spine Contraindication to pamidronate (hypocalcemia, severe kidney failure, or allergy) Underage patients, patients under the protection of the law Previous treatment with bisphosphonates Pregnancy Local or general infection Previous discal surgery Systemic corticosteroid therapy in the last month Epidural or facet joint corticosteroid injection in the last month History of septic spondylodiscitis Ankylosing spondylitis Low back pain associated with radiculalgia Active psychiatric disorder Inability to read or understand French Body temperature above 38°C (fever) or Erythrocyte Sedimentation Rate above 20mm/hour

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pamidronate<br>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 | Drug: Pamidronate<br> <br> |
| Other: Placebo<br>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 | Other: Placebo<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| back pain assessed on a100mm VAS |  | at 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| - Functional status using EIFEL, Dallas, FABQ, MacTar, and MCII/PASS questionnaires |  | at 6 weeks, 3 months, and 6 months | 
| Back stiffness assessed by Schober's test and finger-to-floor distance |  | 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 | 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 | at 6 weeks, 3 months, and 6 months | 
| Tolerance based on the number and types of side-effects |  | at 6 weeks, 3 months, and 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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MODIC changes, Chronic low back pain, Pamidronate, Magnetic resonance imaging, Vertebrae, Intervertebral disc