Pamidronate Works Again in the Back – This Time For the Worst – Spinal Stenosis

Spinal stensois is a horrible disease often thought that surgery is the only outlet (though steroid blocks might have some “limited” effect).  Now again pamidronate has been shown to stem tide of pain with a mean improvement of 40%. Not a controlled trial; but still encouraging. Old study but new to me…

Feld, Joy, et al.
An open study of pamidronate in the treatment of refractory degenerative lumbar spinal stenosis.
Clinical rheumatology 28.6 (2009): 715-717.

  • 24 patients, 19 of them female
  • age 71 ±11 years
  • monthly  X 3 intravenous pamidronate 60 mg in 500 cc normal saline, over 4 hours.
  • “After 3 months, those patients reporting some clinical response received additional three monthly infusions.”
  • If creatinine levels between 1.5 mg/dl [132.6 umol/L] and 2.0 mg/dl [176.8umol/l], then given a reduced dose of pamidronate, 30 mg, and  “those with more severe renal decline exclude”
  • Results:
    65% percent improved including the claudication
  • VAS score prior to treatment average went from 7.6 /10 to 4.6/10  (P<0.001).
  • “The mean percentage improvement was 40%.”

Side effects:
“Five patients suffered a flu-like systemic inflammatory reaction which appeared within several hours after the first infusion.”  – a known side effect where some authors routine suggest pretreatment with ibuprofen or naproxen or acetaminophen

Long term (verbatum):

  • “Nine patients were reassessed 8 months after completion of their course of therapy, four patients after a year, and one patient after 2 years.
  • Six of the patients had no recurrence of their clinical symptoms of intermittent claudication during the follow-up period; one patient reporting recurrence after 3 months; four patients’ symptoms recurred after 6 months, and that of three patients after a year.
  • Four patients received a second course of treatment after recurrence, at their own request, with similar improvement to their first course of treatment in three.
  • None of the patients in this pilot trial had deteriorated nor have undergone spine surgery following treatment”

Comment – an exciting possibility for a horrible disease

Its effects on chronic back pain was exciting:

I wrote about it here:
Chronic Back Pain May Be a Pamidronate Infusion Treatable Disease – And Why Did It take 10 Years to Replicate That?

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