Modic Changes and Back Pain

Modic changes are the name given to pathological changes that are present in the bones of the spine; this was first mentioned by Dr Michael Modic in 1988. Modic Changes is a ‘disease’ process, which is linked with spinal inflammation that has not been responsive to conventional treatments. It is also related to poor healing and recurrent disc herniation.


Types of Modic Changes

There are three types of Modic changes namely Type I, Type II, and Type III


Significance of Modic Changes on Back Pain

Modic changes are considered to be one of the leading causes of low back pain after spinal stenosis or disc herniation. Studies suggest that there is a strong relationship between Modic type 1 changes and chronic low back pain.


How are Modic Changes Diagnosed?

Modic changes can only be diagnosed through MRI scans. Indications for imaging would be a person reporting constant, unrelenting back pain, which is present 24 hours a day and making it difficult for the person to sleep, work or carry out the normal activities of daily living.


New discoveries

I was fortunate to meet Hanne Albert a multi awarding winning health professional at an international spine and pain conference where she presented her study on Modic changes and antibiotics therapy.  Her well-received research was funded by the Danish Rheumatism Association and other foundations and carried out in university hospitals in Denmark. Albert’s findings were published in the peer-reviewed European Spine Journal. A related study in the same journal and by the same researchers provided good quality evidence that some types of lower back pain are associated with bacterial infection.

Albert’s research looked at how to treat the anaerobic bacteria that live in the disc. Interestingly spinal disc has no blood supply which provides the perfect anaerobic atmosphere. Just like an anaerobic exercise in us produces acid, lactic acid,  which is painful, these anaerobic bacteria produces propionic acid which leaches out of the disc into the bone which then corrodes, and microfractures which are extremely painful, it is the bone that hurts rather than the disc itself.


What were the results?

This well-designed double-blind RCT showed that the antibiotic treatment of chronic lower back pain caused by swelling of the spinal vertebrae is more effective than placebo at reducing back pain and disease-related disability. However, as strong as this research it is, it is not definitive. Further research is needed, to confirm these findings before any treatment is likely to be approved and licensed for routine use in the UK. There will also need to be extensive safety investigations.

Albert’s astounding series of discoveries have led to the advent of MAST (Modic Antibiotic spine therapy).This revolutionary, simple, and extraordinarily effective treatment is appropriate to somewhere in the region of 20-40% of all sufferers of chronic low back pain for those with the MAST diagnosis this treatment can cure up to 80% of them.


Conclusion

The cause of Modic changes are debated in scientific medical research though the treatment is more or less seems to be leaning towards conservative treatment for back pain with surgery for the most challenging cases or those that involve significant neurological impairment such as numbness and weakness.The discoveries of Hannah Albert and her team require us to reconsider our understanding of chronic low back pain. Modic-related low back pain accounts for perhaps 20-40% of all chronic low back pain.


Refs:

Antibiotic treatment in patients with chronic low back pain and vertebral bone oedema (Modic type 1 changes): a double-blind, randomised clinical controlled trial of efficacy Albert H B, et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631045

Rwww.nhs.uk/news/2013/05May/Pages/Antibiotics-may-help-ease-chronic-back-pain.aspx


Please note: This is for guidance only, it should not be considered a substitute for medical advice, diagnosis or treatment given in person by an appropriately trained health professional