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The association between Modic changes and pain during 1-year follow-up in patients with lumbar radicular pain

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Abstract

Objective

To examine whether Modic changes influence pain during a 1-year follow-up in patients with lumbar radicular pain.

Materials and Methods

A total of 243 patients with lumbar radicular pain due to disc herniation were recruited from two hospitals in Norway and followed up at 6 weeks, 6 months, and 12 months. On baseline lumbar magnetic resonance images, two observers independently evaluated Modic changes (types I–III; craniocaudal size 0–3). Outcomes were sensory pain (McGill Pain Questionnaire), back and leg pain (visual analogue scale, VAS). Association between Modic type and outcomes was explored with a mixed model and then by two-way analysis of variance (ANOVA) at each time point with Modic and treatment groups (surgical, n = 126; nonsurgical, n = 117) as fixed factors, adjusted for disc degeneration, age, sex, smoking, and duration of radicular pain. Modic size was also analyzed using ANOVA.

Results

Pain scores had decreased significantly at 1-year follow-up. Modic type was significantly related to McGill sensory scores (mixed model: p = 0.014–0.026; ANOVA: p = 0.007 at 6 weeks), but not to VAS back pain or VAS leg pain scores. At 6 weeks, the mean McGill sensory score was higher in Modic I than in Modic II–III patients (p = 0.003) and in patients without Modic changes (p = 0.018). Modic size L1–S1 was not associated with pain outcomes.

Conclusion

Patients with lumbar radicular pain have a substantial pain reduction during 1-year follow-up, but Modic type I changes may imply a slower initial decrease in sensory pain.

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Acknowledgements

The study received financial support from the South Eastern Norway Regional Health Authority, the Western Norway Regional Health Authority, Haakon and Sigrun Ødegaard’s Fund at the Norwegian Society of Radiology, the Norwegian Research Council, and the Norwegian Extra Foundation for Health and Rehabilitation through the Norwegian Back Pain Association. We thank Anette Storesund for help with data collection and Leiv Sandvik for statistical advice.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ullevål, Nydalen, Postbox 4956, 0424, Oslo, Norway

    Elina Iordanova Schistad & Cecilie Røe

  2. Faculty of Medicine, University of Oslo, Oslo, Norway

    Elina Iordanova Schistad & Cecilie Røe

  3. Department of Radiology, Haukeland University Hospital, Bergen, Norway

    Ansgar Espeland

  4. Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Ansgar Espeland

  5. Department of Anesthesiology, Haukeland University Hospital, Bergen, Norway

    Lars Jørgen Rygh

  6. National Institute of Occupational Health, Oslo, Norway

    Johannes Gjerstad

  7. Department of Molecular Biosciences, University of Oslo, Oslo, Norway

    Johannes Gjerstad

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  1. Elina Iordanova Schistad
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  2. Ansgar Espeland
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Correspondence to Elina Iordanova Schistad.

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Schistad, E.I., Espeland, A., Rygh, L.J. et al. The association between Modic changes and pain during 1-year follow-up in patients with lumbar radicular pain. Skeletal Radiol 43, 1271–1279 (2014). https://doi.org/10.1007/s00256-014-1928-0

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  • DOI: https://doi.org/10.1007/s00256-014-1928-0

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