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Are the presence of MODIC changes on MRI scans related to "improvement" in low back pain patients treated with lumbar facet joint injections?

ABSTRACT: Modic changes (MC) have been linked with low back pain (LBP) and worse outcomes from some treatments. No studies have investigated the impact that MCs may have on patient outcomes from lumbar facet injections. Therefore, the purpose of this study is to investigate whether the presence of Modic changes is related to 'improvement' in patients undergoing imaging-guided lumbar facet injection therapy.Outcomes from 226 patients with MRI scans within 3 months of their imaging-guided lumbar facet injections were investigated to determine whether MCs are related to 'improvement' post injection. At 1 day, 1 week and 1 month post injection the Patients Global Impression of Change scale answers were collected by postal questionnaire. This was the primary outcome measure. The numerical rating scale for pain data was collected prior to treatment and at the same post injection time points. The MRI scans were independently evaluated by two examiners for the presence/absence of Modic changes and the type of Modic change if present. Kappa statistics were used for reliability of diagnosis analysis. Chi-squared test and logistic regression analysis tested MCs with 'improvement'.Intra- and inter-examiner reliability for the diagnosis of MCs was Kappa?=?0.77 and 0.74. Intra- and inter-examiner reliability for categorizing MCs was K?=?0.77 and K?=?0.78. At 1 month post injection 45.2 % of patients without MCs reported clinically relevant 'improvement' compared to 34.2 % of patients with MC I and 32.1 % of patients with MC II. However, this did not reach statistical significance. Logistic regression found that Modic changes were not predictive of 'improvement'.There was a tendency for patients without MCs to have better outcomes but this did not reach statistical significance. The reliability of diagnosing MCs was substantial.

SUBMITTER: Bianchi M

PROVIDER: S-EPMC4558765 | biostudies-other | 2015 Sep

REPOSITORIES: biostudies-other

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Are the presence of MODIC changes on MRI scans related to "improvement" in low back pain patients treated with lumbar facet joint injections?

Bianchi Matilde M Peterson Cynthia K CK Pfirrmann Christian W A CW Hodler Juerg J Bolton Jennifer J

BMC musculoskeletal disorders 20150904

<h4>Background</h4>Modic changes (MC) have been linked with low back pain (LBP) and worse outcomes from some treatments. No studies have investigated the impact that MCs may have on patient outcomes from lumbar facet injections. Therefore, the purpose of this study is to investigate whether the presence of Modic changes is related to 'improvement' in patients undergoing imaging-guided lumbar facet injection therapy.<h4>Methods</h4>Outcomes from 226 patients with MRI scans within 3 months of thei ...[more]

PMID: 26338033

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Project description:BACKGROUND:The role of injections of therapeutic substances into the back as treatment for low back pain is unclear. Facet joint injections are widely used despite the absence of evidence of sustained benefit. We hypothesise that facet joint injections might facilitate engagement with physiotherapist-led, best usual care (a combined physical and psychological programme) and is a clinically and cost-effective treatment for people with suspected low back pain of facet joint origin. METHODS/DESIGN:We present here the protocol for a randomised controlled feasibility trial for a main trial to test the above hypotheses. Patients referred to secondary care with persistent non-specific low back pain will be screened and invited to take part in the study. Those who meet the eligibility criteria will be invited for a physiotherapy assessment to confirm trial eligibility and for baseline data collection. All participants (n?=?150) will be offered the best usual care package with physical and psychological components. Those randomised into the intervention arm (n?=?75) will, in addition, receive intra-articular facet joint injections with local anaesthetic and steroids. Primary outcome data will be collected using daily and then weekly text messaging service for a pain score on a 0-10 scale. Questionnaire follow-up will be at 3, 6, and 12 months. Evaluation of trial processes and health economic analyses, including a value of information analysis, will be undertaken. The process evaluation will be mixed methods and will include the views of all stakeholders. DISCUSSION:Whilst this trial is a feasibility study it is currently one of the largest trials in this area. The outcomes will provide some evidence on the use of facet joint injections for patients with clinically diagnosed facet joint pain. TRIAL REGISTRATION:EudraCT identifier 2014-000682-50, (registered on 12 February 14). ISRCTN registry number: ISRCTN93184143 DOI 10.1186/ISRCTN93184143 (registered on 27 February 2014).

Dataset Information

Are the presence of MODIC changes on MRI scans related to "improvement" in low back pain patients treated with lumbar facet joint injections?

Publications

Are the presence of MODIC changes on MRI scans related to "improvement" in low back pain patients treated with lumbar facet joint injections?

Similar Datasets

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