Pamidronate is ineffective for inflammatory-like low back pain associated with Modic type 1 changes: A double-blind, randomised controlled trial
In brief
Pamidronate provides brief 6-week pain drop but no benefit at 3 months
In a double-blind trial of 44 adults with Modic type 1 low back pain, intravenous pamidronate lowered pain scores by about 14 mm on the visual analogue scale at six weeks, but the effect vanished by three months and overall pain reduction was not different from placebo. More side effects, mainly flu-like symptoms, occurred with pamidronate, limiting its usefulness.
- Journal
- Osteoarthritis and cartilage open (Q1)
- Published
- 23 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Martin Soubrier, Charlotte Lanhers, Bruno Pereira, Angélique Fan, Sandrine Malochet Guinamand, Marion Couderc, et al.
- PMID
- 42569384
- DOI
- 10.1016/j.ocarto.2026.100851
Why clinicians should know about it
- Picked for Rehabilitation (paper of the day, 9 August 2026).
Abstract
OBJECTIVE: Modic type 1 (MC-1) vertebral endplate changes are associated with chronic low back pain (LBP) and often reflect an inflammatory process. Pamidronate has demonstrated analgesic effects in conditions involving bone marrow oedema. Our study aimed to evaluate the efficacy of intravenous pamidronate in patients with inflammatory-like LBP and MRI-confirmed MC-1 changes. METHOD: In the PEPTIDE study, a single-centre, randomised, double blind, placebo-controlled trial, adults aged 18-60 years with chronic inflammatory-like LBP unresponsive or intolerant to NSAIDs, and MRI-confirmed MC-1 were randomised (1:1) to receive either two consecutive daily infusions of pamidronate (90 mg) or placebo. The primary endpoint was the change in LBP intensity (VAS pain) after 3 months. Secondary outcomes included functional disability, quality of life, inflammatory symptoms, and analgesic consumption. RESULTS: Forty-four participants (mean age 49.4 ± 8.9 years; 57% women) were randomised. At 3 months, the between-group difference in VAS pain reduction was not significant (difference -6.4 mm; 95%CI: -22.0 to 9.3). At 6 weeks, there was a trend toward pain improvement with pamidronate (difference -14.15 mm; 95% CI -28.85 to 0.55). Significantly more patients in the pamidronate group achieved predefined pain improvement thresholds, although this effect was not maintained at 3 or 6 months. Adverse events occurred more frequently in the pamidronate group (54.6% vs 27.3%), primarily flu-like symptoms. CONCLUSION: These findings are consistent with previous studies suggesting that bisphosphonates may provide a transient analgesic effect at 6 weeks but do not confer sustained clinical benefit at 3 or 6 months in MC-1-associated low back pain.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.