Modic Change and Chronic Pain
Chronic spinal pain associated with Modic changes.
What are Modic changes?
Modic changes are inflammatory disruptions in the vertebrae (bones) of our spine. This is part of a process that happens after a disc has been damaged for a long time (6+ months). Imagine the discs in the low back to be like the soft, white of an Oreo and the vertebra (bone) to be the hard, black cookie. What happens with Modic changes is the disc will infiltrate the bone. The Oreo is cracked and the soft, white center is pushing through the cookie. This creates swelling, inflammation, and even fracturing in the bone.
How do I know if I have them?
The gold standard for confirming this condition is an MRI. A good radiologist will note these problems on his/her report and comment which type of lesion is present. There are 3 categories of Modic lesions to the vertebrae. Modic type I, type II, or type III. As you can imagine, the bigger the number the more progressed the diagnosis. Type I is inflammation and swelling in the bone, imagine a blister in the bone. This is typically the most painful Modic lesion. Type II is where the marrow of the bone is replaced with fat. Type III has progressed to the point where the bone begins to microfracture and become sclerotic (hardening of bone).
What can be done?
This condition has been gaining attention in the research community as an underlooked diagnosis for chronic low back pain. At the moment, the treatment interventions include conservative care, lumbar fusion, nerve ablation, or stem cell therapy. As you can see there is quite the variety. One option is extremely invasive and another is a trip or 2 each week to the chiro/PT. How can your options be so varied? What is being missed? Or more importantly what isn’t being diagnosed?
According to this multi-centered surgical study, https://clinicaltrials.gov/ct2/show/results/NCT01446419?view=results, 55% of patients reported improvement from their nerve ablation treatment. In comparison, 45% of the sham group reported improvement.
What that means is about half of the time you’ll feel better with or without surgical intervention. Would you want those odds going into surgery?
What can Functional Pain Relief do?
The reason there are multiple treatment options is because there is more than meets the eye with Modic lesions. For the spine to get to this degenerative state it has to undergo months to years of breakdown. This rarely happens in isolation. So the question now becomes, what else is going on?
Do you have a range of motion deficit?
Are you strong enough to do simple daily tasks?
Do you have a metabolic condition that limits your body’s ability to heal?
All of these factors will compound stress and/or load to your spine. Furthering the degenerative process and causing the Modic lesions to worsen.
So, being a conservative care clinic we must ask the question
“What can be done to unload the spine and put it in a healing environment?”
A lot.
We utilize FastMap™ (sample picture below) in our office. This is software from Integrative Diagnosis® that helps us determine how much of a patient’s problem is coming from a structural (bone, joints, ligaments) deficit versus a functional (ROM, soft tissues and strength) deficit. Once we know the FastMap™ score, a purpose built exam will be done to determine the complete diagnosis.
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Knowing how poor a patient’s ROM is or how weak they are is extremely important in cases that don’t require surgery.
I think it’s safe to say no one wakes up one day and thinks “you know what? I want surgery.” They will do everything they can to avoid it. We are the place for you if avoiding surgery is what you want.
Before you get another injection or your nerves burned or your spine fused talk to us first.
Let us help you understand your condition and find out, together, if your functional deficits outweigh the structural. More times than not, when Modic changes are present, surgery is not necessary. But it does take a skilled doctor to determine the best treatment options.
We help patients every week who have Modic changes in their spine.
Some of them have already had surgery and some want to avoid it. Whatever the case may be, the success lies in the doctor’s ability to diagnose the condition in its entirety. Once that is completed it is then determined what the best course of action will be and should be communicated properly to the patient.
Rest assured we at Functional Pain Relief have your best interest in mind and will do all we can to get you on the path to a happier, healthier pain-free life.