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Pamidronate Shows Potential in Chronic Back Pain: Presented at AAPM

By Jill Stein
Special to DG News

NEW ORLEANS, LA -- February 21, 2003 -- Treatment with intravenous pamidronate may help decrease chronic, debilitating mechanical spine pain, according to results presented here on February 20^th at the 19^th Annual Meeting of the American Academy of Pain Medicine.

Dr. Marco Pappagallo and colleagues at New York University School of Medicine in administered, on a compassionate basis, 90 mg infusions of the bisphosphonate pamidronate over 4 hours to 25 patients. All patients had three infusions, with a 4-week interval between infusions.

The study was prompted by earlier research showing that pamidronate has a palliative analgesic effect in metastatic bone pain, Dr. Pappagallo pointed out. Bisphosphonate treatment has also been reported effective in a variety of painful conditions not associated with cancer or osteoarthritis, including ankylosing spondylitis, complex regional pain syndrome, inflammatory bone and joint conditions, rheumatoid arthritis and visceral pain in animals.

He noted that it is also possible that mechanisms that cause cancer-related and non-cancer spinal pain are similar.

In the present study, all patients rated their pain on a 0-10 numeric scale, where 0 indicated a complete absence of pain and 10 referred to the worst conceivable pain.

To assess the alleviation of pain associated with pamidronate treatment, the investigators compared pain scores noted before the first infusion to those reported 1 month after the last monthly infusion.

Twenty three of the 25 patients had a change in pain intensity during the study; 91% reported an improvement/decrease in pain via the numeric rating scale. The mean numeric rating scale decrease was 3.6 points, and the mean percentage reduction in numeric rating scale scores was 41% (p<0.0001).

In addition, 78% reported an absolute reduction in the numeric rating scale pain score of at least 2 points. In 57%, the percentage reduction in numeric rating pain scale scores was at least 30%.

No patient showed any signs or complaints suggestive of hypocalcaemia. Post- infusion laboratory blood tests showed no relevant changes from baseline.

While the researchers did not document whether patients developed discomfort, they estimated that 10% of subjects experienced discomfort at the intravenous site, which subsided in 1 to 15 days, and 40% to 50% developed mild diffuse body aches and transient fever after treatment.

Dr. Pappagallo's team called for a randomised, placebo-controlled, double-blind study to substantiate the benefits of pamidronate treatment in chronic mechanical spine pain seen in this study.


[Study title: A Pilot Trial of Intravenous Pamidronate for chronic Mechanical Spine Pain]

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