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. 2018 Jul 17:11:1335-1342.
doi: 10.2147/JPR.S158718. eCollection 2018.

Clinical efficacy of calcitonin compared to diclofenac sodium in chronic nonspecific low back pain with type I Modic changes: a retrospective study

Jiaming Zhou  1   2 , Tengshuai Li  1 , Liandong Li  1 , Yuan Xue  1
Affiliations

Clinical efficacy of calcitonin compared to diclofenac sodium in chronic nonspecific low back pain with type I Modic changes: a retrospective study

Jiaming Zhou et al. J Pain Res. .

Abstract

Background: The objective of this study was to compare the efficacy of calcitonin with diclofenac sodium in the treatment of patients with nonspecific low back pain (LBP) and type I Modic changes (MC1).

Patients and methods: The study was a retrospective observational study with 109 patients who had nonspecific LBP and MC1 that appeared as bone marrow lesions on magnetic resonance imaging (MRI). Between October 2013 and March 2016, 62 patients were injected intramuscularly with calcitonin 50 IU once daily and 47 patients were treated with diclofenac 75 mg once per day for 4 weeks for the treatment of LBP associated with MC1 on MRI. Visual analog scale (VAS) (0-10) and Oswestry Disability Index (ODI) (0-100) questionnaires were acquired from clinical records to evaluate LBP perception and degree of disability. Imaging data were also collected before and after treatment.

Results: Significant improvements were found in VAS and ODI at posttreatment compared with baseline in both groups (P < 0.05). Meanwhile, there was a significant difference between calcitonin group and diclofenac group at both 4 weeks and 3 months of follow-up (4 weeks: VAS 4.46 ± 1.58 vs 5.08 ± 1.50, ODI 20.32 ± 9.64 vs 24.35 ± 7.95; 3 months: VAS 3.70 ± 1.74 vs 4.51 ± 1.67, ODI 16.67 ± 9.04 vs 21.18 ± 9.56; P < 0.05 for all). Moreover, the proportion of patients with a significant change in LBP scales was higher in the calcitonin group (4 weeks: VAS 50.00% vs 23.40%, ODI 54.83% vs 25.53%; 3 months: VAS 58.06% vs 38.29%, ODI 59.67% vs 38.29%; P < 0.05 for all). According to MRI, 43.54% patients in the calcitonin group showed improvement compared with 21.27% patients in the diclofenac group (P < 0.05).

Conclusion: There was greater short-term efficacy of calcitonin compared with diclofenac in patients with LBP and MC1 on MRI.

Keywords: Modic changes; bone marrow lesions; calcitonin; diclofenac sodium; low back pain.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
A patient with MC1 (arrows) on MRI: low intensity on T1-weighted image (A) and high intensity on T2-weighted image (B). After calcitonin treatment, no abnormal signal intensity was found on T1- and T2-weighted images (C, D). Abbreviations: MC1, type I Modic changes; MRI, magnetic resonance imaging.
Figure 2
Figure 2
A patient with MC1 (white arrows) on MRI: low intensity on T1-weighted image (A) and high intensity on T2-weighted image (B). After calcitonin treatment, MC1 converted to MC2 (high signal intensity on T1- and T2-weighted images) (red arrows) (C, D). Abbreviations: MC1, type I Modic changes; MRI, magnetic resonance imaging; MC2, type II Modic changes.
See this image and copyright information in PMC

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