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

Authors Zhou J, Li T, Li L, Xue Y

Received 2 December 2017

Accepted for publication 5 May 2018

Published 17 July 2018 Volume 2018:11 Pages 1335—1342

DOI https://doi.org/10.2147/JPR.S158718

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 3

Editor who approved publication: Dr E. Alfonso Romero-Sandoval


Jiaming Zhou,1,2 Tengshuai Li,1 Liandong Li,1 Yuan Xue1

1Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China; 2Graduate School, Tianjin Medical University, Tianjin, People’s Republic of China

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: calcitonin, diclofenac sodium, Modic changes, bone marrow lesions, low back pain

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