Antibiotic treatment In patients with chronic low back pain and Modic changes (the AIM study): study protocol for a randomised controlled trial
Background A previous randomised controlled trial (RCT) of patients with chronic low back pain (LBP) and vertebral bone marrow (Modic) changes (MCs) on magnetic resonance imaging (MRI), reported that a 3-month, high-dose course of antibiotics had a better effect than placebo at 12 months’ follow-up....
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| creator | Storheim, Kjersti Espeland, Ansgar Grøvle, Lars Skouen, Jan S Aßmus, Jörg Anke, Audny Froholdt, Anne Pedersen, Linda M Haugen, Anne J Fors, Terese Schistad, Elina Lutro, Olav Marchand, Gunn H Kadar, Thomas Vetti, Nils Randen, Sigrun Nygaard, Øystein Petter Brox, Jens Ivar Grotle, Margreth Zwart, John-Anker |
| description | Background
A previous randomised controlled trial (RCT) of patients with chronic low back pain (LBP) and vertebral bone marrow (Modic) changes (MCs) on magnetic resonance imaging (MRI), reported that a 3-month, high-dose course of antibiotics had a better effect than placebo at 12 months’ follow-up. The present study examines the effects of antibiotic treatment in chronic LBP patients with MCs at the level of a lumbar disc herniation, similar to the previous study. It also aims to assess the cost-effectiveness of the treatment, refine the MRI assessment of MCs, and further evaluate the impact of the treatment and the pathogenesis of MCs by studying genetic variability and the gene and protein expression of inflammatory biomarkers.
Methods/design
A double-blinded RCT is conducted at six hospitals in Norway, comparing orally administered amoxicillin 750 mg, or placebo three times a day, over a period of 100 days in patients with chronic LBP and type I or II MCs at the level of a MRI-confirmed lumbar disc herniation within the preceding 2 years. The inclusion will be stopped when at least 80 patients are included in each of the two MC type groups. In each MC type group, the study is designed to detect (β = 0.1, α = 0.05) a mean difference of 4 (standard deviation 5) in the Roland Morris Disability Questionnaire score between the two treatment groups (amoxicillin or placebo) at 1-year follow-up. The study includes cost-effectiveness measures. Blood samples are assessed for security measures and for possible inflammatory mediators and biomarkers at different time points. MCs are evaluated on MRI at baseline and after 12 months. A blinded intention-to-treat analysis of treatment effects will be performed in the total sample and in each MC type group.
Discussion
To ensure the appropriate use of antibiotic treatment, its effect in chronic LBP patients with MCs should be re-assessed. This study will investigate the effects and cost-effectiveness of amoxicillin in patients with chronic LBP and MCs at the level of a disc herniation. The study may also help to refine imaging and characterise the biomarkers of MCs.
Trial registration
ClinicalTrials.gov, ID:
NCT02323412
. Registered on 21 November 2014. |
| doi_str_mv | 10.1186/s13063-017-2306-8 |
| format | Article |
| fullrecord | <record><control><sourceid>cristin_3HK</sourceid><recordid>TN_cdi_cristin_nora_10852_59380</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>10852_59380</sourcerecordid><originalsourceid>FETCH-cristin_nora_10852_593803</originalsourceid><addsrcrecordid>eNqFi7FOAzEQRN1QoMAHULFlKA7snJJc6CIEIkU6-tPG5-RWcXaj9aKIr-CXsQQ91TzNvHHuLvjHELrFUwmtX7SND8tmVqnprt33mo12JEYRTBPaKbHBhuGMRhULXMhGiKMKVyXLBXYYj3UmBuQBtjLUPo7Ih1RgamOC9WYLxT6Hr4fn34SzikmUDHtRQNB6lBOVNEAUNpWcK5oS5ht3tcdc0u1fTtz92-vHy3sTlYoR9yyKffDdfNbPV23n2_-NH02MUfw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Antibiotic treatment In patients with chronic low back pain and Modic changes (the AIM study): study protocol for a randomised controlled trial</title><source>NORA - Norwegian Open Research Archives</source><creator>Storheim, Kjersti ; Espeland, Ansgar ; Grøvle, Lars ; Skouen, Jan S ; Aßmus, Jörg ; Anke, Audny ; Froholdt, Anne ; Pedersen, Linda M ; Haugen, Anne J ; Fors, Terese ; Schistad, Elina ; Lutro, Olav ; Marchand, Gunn H ; Kadar, Thomas ; Vetti, Nils ; Randen, Sigrun ; Nygaard, Øystein Petter ; Brox, Jens Ivar ; Grotle, Margreth ; Zwart, John-Anker</creator><creatorcontrib>Storheim, Kjersti ; Espeland, Ansgar ; Grøvle, Lars ; Skouen, Jan S ; Aßmus, Jörg ; Anke, Audny ; Froholdt, Anne ; Pedersen, Linda M ; Haugen, Anne J ; Fors, Terese ; Schistad, Elina ; Lutro, Olav ; Marchand, Gunn H ; Kadar, Thomas ; Vetti, Nils ; Randen, Sigrun ; Nygaard, Øystein Petter ; Brox, Jens Ivar ; Grotle, Margreth ; Zwart, John-Anker</creatorcontrib><description>Background
A previous randomised controlled trial (RCT) of patients with chronic low back pain (LBP) and vertebral bone marrow (Modic) changes (MCs) on magnetic resonance imaging (MRI), reported that a 3-month, high-dose course of antibiotics had a better effect than placebo at 12 months’ follow-up. The present study examines the effects of antibiotic treatment in chronic LBP patients with MCs at the level of a lumbar disc herniation, similar to the previous study. It also aims to assess the cost-effectiveness of the treatment, refine the MRI assessment of MCs, and further evaluate the impact of the treatment and the pathogenesis of MCs by studying genetic variability and the gene and protein expression of inflammatory biomarkers.
Methods/design
A double-blinded RCT is conducted at six hospitals in Norway, comparing orally administered amoxicillin 750 mg, or placebo three times a day, over a period of 100 days in patients with chronic LBP and type I or II MCs at the level of a MRI-confirmed lumbar disc herniation within the preceding 2 years. The inclusion will be stopped when at least 80 patients are included in each of the two MC type groups. In each MC type group, the study is designed to detect (β = 0.1, α = 0.05) a mean difference of 4 (standard deviation 5) in the Roland Morris Disability Questionnaire score between the two treatment groups (amoxicillin or placebo) at 1-year follow-up. The study includes cost-effectiveness measures. Blood samples are assessed for security measures and for possible inflammatory mediators and biomarkers at different time points. MCs are evaluated on MRI at baseline and after 12 months. A blinded intention-to-treat analysis of treatment effects will be performed in the total sample and in each MC type group.
Discussion
To ensure the appropriate use of antibiotic treatment, its effect in chronic LBP patients with MCs should be re-assessed. This study will investigate the effects and cost-effectiveness of amoxicillin in patients with chronic LBP and MCs at the level of a disc herniation. The study may also help to refine imaging and characterise the biomarkers of MCs.
Trial registration
ClinicalTrials.gov, ID:
NCT02323412
. Registered on 21 November 2014.</description><identifier>DOI: 10.1186/s13063-017-2306-8</identifier><language>eng</language><creationdate>2017</creationdate><rights>info:eu-repo/semantics/openAccess</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,780,885,26567</link.rule.ids><linktorsrc>$$Uhttp://hdl.handle.net/10852/59380$$EView_record_in_NORA$$FView_record_in_$$GNORA$$Hfree_for_read</linktorsrc></links><search><creatorcontrib>Storheim, Kjersti</creatorcontrib><creatorcontrib>Espeland, Ansgar</creatorcontrib><creatorcontrib>Grøvle, Lars</creatorcontrib><creatorcontrib>Skouen, Jan S</creatorcontrib><creatorcontrib>Aßmus, Jörg</creatorcontrib><creatorcontrib>Anke, Audny</creatorcontrib><creatorcontrib>Froholdt, Anne</creatorcontrib><creatorcontrib>Pedersen, Linda M</creatorcontrib><creatorcontrib>Haugen, Anne J</creatorcontrib><creatorcontrib>Fors, Terese</creatorcontrib><creatorcontrib>Schistad, Elina</creatorcontrib><creatorcontrib>Lutro, Olav</creatorcontrib><creatorcontrib>Marchand, Gunn H</creatorcontrib><creatorcontrib>Kadar, Thomas</creatorcontrib><creatorcontrib>Vetti, Nils</creatorcontrib><creatorcontrib>Randen, Sigrun</creatorcontrib><creatorcontrib>Nygaard, Øystein Petter</creatorcontrib><creatorcontrib>Brox, Jens Ivar</creatorcontrib><creatorcontrib>Grotle, Margreth</creatorcontrib><creatorcontrib>Zwart, John-Anker</creatorcontrib><title>Antibiotic treatment In patients with chronic low back pain and Modic changes (the AIM study): study protocol for a randomised controlled trial</title><description>Background
A previous randomised controlled trial (RCT) of patients with chronic low back pain (LBP) and vertebral bone marrow (Modic) changes (MCs) on magnetic resonance imaging (MRI), reported that a 3-month, high-dose course of antibiotics had a better effect than placebo at 12 months’ follow-up. The present study examines the effects of antibiotic treatment in chronic LBP patients with MCs at the level of a lumbar disc herniation, similar to the previous study. It also aims to assess the cost-effectiveness of the treatment, refine the MRI assessment of MCs, and further evaluate the impact of the treatment and the pathogenesis of MCs by studying genetic variability and the gene and protein expression of inflammatory biomarkers.
Methods/design
A double-blinded RCT is conducted at six hospitals in Norway, comparing orally administered amoxicillin 750 mg, or placebo three times a day, over a period of 100 days in patients with chronic LBP and type I or II MCs at the level of a MRI-confirmed lumbar disc herniation within the preceding 2 years. The inclusion will be stopped when at least 80 patients are included in each of the two MC type groups. In each MC type group, the study is designed to detect (β = 0.1, α = 0.05) a mean difference of 4 (standard deviation 5) in the Roland Morris Disability Questionnaire score between the two treatment groups (amoxicillin or placebo) at 1-year follow-up. The study includes cost-effectiveness measures. Blood samples are assessed for security measures and for possible inflammatory mediators and biomarkers at different time points. MCs are evaluated on MRI at baseline and after 12 months. A blinded intention-to-treat analysis of treatment effects will be performed in the total sample and in each MC type group.
Discussion
To ensure the appropriate use of antibiotic treatment, its effect in chronic LBP patients with MCs should be re-assessed. This study will investigate the effects and cost-effectiveness of amoxicillin in patients with chronic LBP and MCs at the level of a disc herniation. The study may also help to refine imaging and characterise the biomarkers of MCs.
Trial registration
ClinicalTrials.gov, ID:
NCT02323412
. Registered on 21 November 2014.</description><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>3HK</sourceid><recordid>eNqFi7FOAzEQRN1QoMAHULFlKA7snJJc6CIEIkU6-tPG5-RWcXaj9aKIr-CXsQQ91TzNvHHuLvjHELrFUwmtX7SND8tmVqnprt33mo12JEYRTBPaKbHBhuGMRhULXMhGiKMKVyXLBXYYj3UmBuQBtjLUPo7Ih1RgamOC9WYLxT6Hr4fn34SzikmUDHtRQNB6lBOVNEAUNpWcK5oS5ht3tcdc0u1fTtz92-vHy3sTlYoR9yyKffDdfNbPV23n2_-NH02MUfw</recordid><startdate>2017</startdate><enddate>2017</enddate><creator>Storheim, Kjersti</creator><creator>Espeland, Ansgar</creator><creator>Grøvle, Lars</creator><creator>Skouen, Jan S</creator><creator>Aßmus, Jörg</creator><creator>Anke, Audny</creator><creator>Froholdt, Anne</creator><creator>Pedersen, Linda M</creator><creator>Haugen, Anne J</creator><creator>Fors, Terese</creator><creator>Schistad, Elina</creator><creator>Lutro, Olav</creator><creator>Marchand, Gunn H</creator><creator>Kadar, Thomas</creator><creator>Vetti, Nils</creator><creator>Randen, Sigrun</creator><creator>Nygaard, Øystein Petter</creator><creator>Brox, Jens Ivar</creator><creator>Grotle, Margreth</creator><creator>Zwart, John-Anker</creator><scope>3HK</scope></search><sort><creationdate>2017</creationdate><title>Antibiotic treatment In patients with chronic low back pain and Modic changes (the AIM study): study protocol for a randomised controlled trial</title><author>Storheim, Kjersti ; Espeland, Ansgar ; Grøvle, Lars ; Skouen, Jan S ; Aßmus, Jörg ; Anke, Audny ; Froholdt, Anne ; Pedersen, Linda M ; Haugen, Anne J ; Fors, Terese ; Schistad, Elina ; Lutro, Olav ; Marchand, Gunn H ; Kadar, Thomas ; Vetti, Nils ; Randen, Sigrun ; Nygaard, Øystein Petter ; Brox, Jens Ivar ; Grotle, Margreth ; Zwart, John-Anker</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-cristin_nora_10852_593803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><toplevel>online_resources</toplevel><creatorcontrib>Storheim, Kjersti</creatorcontrib><creatorcontrib>Espeland, Ansgar</creatorcontrib><creatorcontrib>Grøvle, Lars</creatorcontrib><creatorcontrib>Skouen, Jan S</creatorcontrib><creatorcontrib>Aßmus, Jörg</creatorcontrib><creatorcontrib>Anke, Audny</creatorcontrib><creatorcontrib>Froholdt, Anne</creatorcontrib><creatorcontrib>Pedersen, Linda M</creatorcontrib><creatorcontrib>Haugen, Anne J</creatorcontrib><creatorcontrib>Fors, Terese</creatorcontrib><creatorcontrib>Schistad, Elina</creatorcontrib><creatorcontrib>Lutro, Olav</creatorcontrib><creatorcontrib>Marchand, Gunn H</creatorcontrib><creatorcontrib>Kadar, Thomas</creatorcontrib><creatorcontrib>Vetti, Nils</creatorcontrib><creatorcontrib>Randen, Sigrun</creatorcontrib><creatorcontrib>Nygaard, Øystein Petter</creatorcontrib><creatorcontrib>Brox, Jens Ivar</creatorcontrib><creatorcontrib>Grotle, Margreth</creatorcontrib><creatorcontrib>Zwart, John-Anker</creatorcontrib><collection>NORA - Norwegian Open Research Archives</collection></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Storheim, Kjersti</au><au>Espeland, Ansgar</au><au>Grøvle, Lars</au><au>Skouen, Jan S</au><au>Aßmus, Jörg</au><au>Anke, Audny</au><au>Froholdt, Anne</au><au>Pedersen, Linda M</au><au>Haugen, Anne J</au><au>Fors, Terese</au><au>Schistad, Elina</au><au>Lutro, Olav</au><au>Marchand, Gunn H</au><au>Kadar, Thomas</au><au>Vetti, Nils</au><au>Randen, Sigrun</au><au>Nygaard, Øystein Petter</au><au>Brox, Jens Ivar</au><au>Grotle, Margreth</au><au>Zwart, John-Anker</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antibiotic treatment In patients with chronic low back pain and Modic changes (the AIM study): study protocol for a randomised controlled trial</atitle><date>2017</date><risdate>2017</risdate><abstract>Background
A previous randomised controlled trial (RCT) of patients with chronic low back pain (LBP) and vertebral bone marrow (Modic) changes (MCs) on magnetic resonance imaging (MRI), reported that a 3-month, high-dose course of antibiotics had a better effect than placebo at 12 months’ follow-up. The present study examines the effects of antibiotic treatment in chronic LBP patients with MCs at the level of a lumbar disc herniation, similar to the previous study. It also aims to assess the cost-effectiveness of the treatment, refine the MRI assessment of MCs, and further evaluate the impact of the treatment and the pathogenesis of MCs by studying genetic variability and the gene and protein expression of inflammatory biomarkers.
Methods/design
A double-blinded RCT is conducted at six hospitals in Norway, comparing orally administered amoxicillin 750 mg, or placebo three times a day, over a period of 100 days in patients with chronic LBP and type I or II MCs at the level of a MRI-confirmed lumbar disc herniation within the preceding 2 years. The inclusion will be stopped when at least 80 patients are included in each of the two MC type groups. In each MC type group, the study is designed to detect (β = 0.1, α = 0.05) a mean difference of 4 (standard deviation 5) in the Roland Morris Disability Questionnaire score between the two treatment groups (amoxicillin or placebo) at 1-year follow-up. The study includes cost-effectiveness measures. Blood samples are assessed for security measures and for possible inflammatory mediators and biomarkers at different time points. MCs are evaluated on MRI at baseline and after 12 months. A blinded intention-to-treat analysis of treatment effects will be performed in the total sample and in each MC type group.
Discussion
To ensure the appropriate use of antibiotic treatment, its effect in chronic LBP patients with MCs should be re-assessed. This study will investigate the effects and cost-effectiveness of amoxicillin in patients with chronic LBP and MCs at the level of a disc herniation. The study may also help to refine imaging and characterise the biomarkers of MCs.
Trial registration
ClinicalTrials.gov, ID:
NCT02323412
. Registered on 21 November 2014.</abstract><doi>10.1186/s13063-017-2306-8</doi><oa>free_for_read</oa></addata></record> |
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| source | NORA - Norwegian Open Research Archives |
| title | Antibiotic treatment In patients with chronic low back pain and Modic changes (the AIM study): study protocol for a randomised controlled trial |
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