Please Assist- Has Anyone got Modic Changes in their Spine & tried Dr Hannah's antibiotic protocol (MAST)?

acelerates the process. I had three sessions in DK, each one hour, and now I expose myself to sun (I am not sun sensible). Before the treatment, I was doing lots of exercise, but now stopped as indicated, because it worsens the condition. Maybe in one year I can start dancing again and running, but I plan to start swiming slowly every day after the AB treatment. I believe that you are to young to fuse the vertebrae, but if you really need it, the fusion can only be done in sound bones. Vertebrae suffering severe modic changes are not able to support fusion. My advise to you is to rest a lot and stop exercising.

Regards, Ana

Just a short update on day 21.  No change in pain relief yet but I have to be patient I know. Side effects are quite manageable, slight irritation in back of throat which comes and goes. Trying to take as few painkillers as possible, but sitting/bending is still the main cause of back pain with referral into the left groin (disc prolapse L2/L3).

Hope that you are doing ok.

Regards,

Dafydd

I am on my day 52, on the beach. Due to the travelling my pain increased, but I am sunbathing twice a day and much better. I notice that the sun hasa tremendous effect on relieving my pain. Have you tried? Check first if the pain killers you take make your skin sun sensible. Some non steroid antiinflammatory do.

My teeth are very stained now, despite washing them several times each day, but I was told that would happen. Apparently a polishing by the dentist after treatment would restore their appearance. I never had anything in my throat.

My pain is also when sitting /bending, worsening by vibrations (car, plane, train, etc). To drive I put a memory foam cushion in my back because it absorbs most of the vibration. The area affected is L4/L5, with degenerated disc and severe modic changes in adjacent vertebrae. My vertebrae have holes in it. If the treatment works, the vertebrae can regenerate, but not the disc. My goal is to stop the infection, if there is one, and decrease the pain by 50%. After the treatment I plan to see a neurosurgeon to have an opinion about that disc.

R

I seem to have similar pain symptoms to yourself, especially anything to do with sitting. Went for two 3/4 hours walks today with a break inbetween, pain quite sore after on left hip side but should settle by tomorrow. I haven't  done any sunbathing but might give it a try.

My goal is the same as yours, to reduce pain by about half would be great. Surgery  frightens me at the moment.

My teeth are also showing signs of staining, but that can be sorted.

Regards,

Dafydd

   I ALSO LIVE IN CANADA, SO I WOULD BE VERY INTERESTED TO SEE IF YOU CAN HAVE THIS ANTIBIOTIC TREATMENT HERE. HOW DID THEY CONFIRM THAT YOU HAD MODIC 1 CHANGES ? DOES YOUR MRI REPORT SAY SO ? I DON'T THINK MINE DOES. THEY TALK ABOUT L5/S1 HERNIATED DISC, ETC., BUT IF THEY DON'T ACTUALLY SPELL OUT THAT YOU HAVE MODIC CHANGES, DO I JUST ASSUME THEN THAT I DON'T. GOOD LUCK.

I would love to hear the results of your biopsy to know whether they really did discover infection. Also to hear if you will take the antibiotic treatment.

Veronika

Just a quick note to say that I did not experience any improvement *at all* until at least 3-4 weeks after I finished the 100 day course. That was in the middle of March. I would now say I have around a 50% improvement from where I was a year ago. I have not taken any painkillers since mid-April, which is a major thing for me as I was on daily codeine for five years. I still have pain bending, lifting, getting in and out of the car and I can't sit on the floor or get in and out of the bath. But the daily knife-in-the-back 24/7 nerve pain has substantially decreased. I've gone back to the gym and have very tentatively started running again. I also walk around 3-5 miles per day. I find that if I slack on the exercise front, things stiffen up again. In December it will be a year since I started the treatment, so I'm still hoping for a bit more improvement if possible. Good luck and don't get too disheartened yet.

Thanks for your words of hope. Bending, lifting, sitting in most chairs and in the car still causes constant pain with left side referral. I also try and walk on most days but not as far as yourself as it again refers to the left side. 

Fingers crossed.

Regards

Dafydd

   I was just wondering if you are still making progress.

   It seems that the antibiotics work for some, but not all ( as Mastdoc explained above ).

   Please let us know how you're doing.

   Good luck,

   William

After being diagnosed with modic 1 changes between L2/3 with slight disc and vertebrae protusion at the broadgate clinic. I took the full AB course for 3 months Co-amoxiclav 500/125mg  2x 3 times a day. It's beemn 2 months since the end of the course and unfortunately the results have been disappointing. Sitting, bending still causes chronic referred pain to the left hand hip side together with lower back pain. There seems to be a slight improvement in walking distances up to one mile but nothing really significant up to now. It was worth trying but seem to have run out of options as any form of surgery does not appeal.

( I apologise for my late reply - Good luck)

Dafydd

Sorry to hear about your lack of response to antibiotics. Perhaps your Modic changes are just mechanical in nature or you may have a low grade of Modic 1 which may not as responsive as higer grades. Modic changes are usually seen first in lower lumbar segments, so there may be some other factors involved.

I would say, if you are beyond a grade 1, there are some other options besides traditional surgery. Intradiscal injections of corticosteriods (not epidurals) have shown good response with Modic changes. There has been a study where a bio-cement was injected for Modic changes and the response was very good. This is a procedure called vertebroplasty. Also, although there are more possible side effects than with antibiotics, a class of drugs called biophosponates are being used with success in treating Modic changes.

So, it may be you are experiencing the effect of the disc herniation more than the Modic changes, and this is possible with early grade 1 Modic type 1 changes, therfore, a simple discectomy may be efficacious and is minimally invasive. However, there are some other options that you could look into. Antibiotics and fusion surgeries are not the only options.

Don't give up or get down!

I hope you are feeling better. I think your pain might be from your disc protusion. That happened to me. I have modic changes type I and II at L5/L4. I have 3 disc protrusions, starting at S1, one degenerated disk (L5/L4) and several degenerated end-plates.  I did the AB treatment and ended up with sciatic pain. I was advised to exercise the core muscles, but after three sessions the condition worsened because the nerves were being more compressed. For the past 8 weeks, 3 times a week, I have been decompressing my spine in a decompression table together with assisted physioterapist exercises and some vitamin B12 injected directly in the spine area. The last two weeks I had Xenon therapy (white pulsing light), vibration and also laser therapy on by lower back. This works really well with this pathology: disk protrusions and degenerated disks and vertebrae. I feel wonderful. I advise you to try this treatment. Before the treatment, I went to a neurosurgeon who told me that if he operated me, removing the degenerated disk and fusing the level - which he though was the correct surgery to do for this problem - he could not guarantee me that I would be pain free.

Good luck.

Ana

Having been diagnosed type I and type II Modic Changes in my L5-S1 vertebrae, I wanted to know if the origin of these was mechanical or infectious. So, yesterday I did a Diffusion Weighted MRI (DW-MRI) and a claw signal was so evident around my modic changes. I guess this means that my Modic Change are not infectious, as the radiologist told me. So, I assume that the antibiotic therapy would not be effective in my case. Would you confirme this? If that's the case what options are there, other than cirurgical, to alleviate the back pain caused by a L5-S1 degenerative disk with degenerative type I and type II Modic changes?

thanks for your help.

Getting a bit more invasive, intradiscal corticosteriod injections - not epidurals, have proven effective, although the number of injections may vary, this seems like a reasonable option and can drastically reduce the inflammation. This is something that could be done which is minimally invasive, and is better done before severe levels of degeneration erode the disc space.

Vertebroplasty being used by injecting a bone cement has also shown effectiveness for Modic changes. This would seem to provide strength, prevent further damage and seal the disc.

Modifications in lifestyle, work, ergonomics and a structurally oriented chiropractor should be looked at to maximize biomechanical efficiency. A good supportive belt can help if there is any lifting over 25 pounds.

One must avoid further damage and reduce mechanical stress. This is no different than with the antibiotics and having to reduce activties and strain. Hopefully, the Type 1 changes are progressing to Type 2, a more stable phase. However, Modic changes are a dynamic process and Type 2 can revert back to Type 1. So, it is my belief that it should be treated as a distinct disease entity and treated medically, legally and socially as such. The scientific evidence does support this as I have extensively documented.

New research is being done. Genetics and stem cell therapies are very promising. Nice job in getting a DWMRI to narrow it down. This does provide clinical reasoning to avoid antibiotics, however; some, like Bactin, are being used to reduce inflammation and nerve growth. This would have to be done on a daily basis, and indefinitely. Sorry the results were claw, but hang in there! We're still early in the process of treating this.

Thank you for your informative reply. I'm so pleased to hear that you are feeling better. I take it that the ABs did not make a great difference to your pain but the that the therapies you described seemed to have helped a great deal with your pain.

I think that you and mastdoc might be right when you say that the pain both referred and back could be mainly coming from the disk protusion.

The brief MRI report which was taken 2.5 years ago said,

' Scattered mild degenerative chages seen throughout. The most significant abnormal area is L2/L3. At this level there are early chages of spinal stenosis produced by a combination of factors. There is a small broad based  posterior disc prolapse. There is also evidence of posterior element hypertrophy. At this level, there is some potential evidence of neural compression in the left lateral recess by the herniated disc. No other significant abnormality is identified'.

I was so disappointed that the AB reatment did not make a significant difference but you have and mastoc have given me some hope of a treatment other than surgery. I wonder if the sort of therapies that you have described are available in the UK, as I take it that you are based in Denmark? 

Thank you for your encouragement.

Dafydd

Thank you for your informative reply. Ana also sent a reply about the cause of the pain being disc related rather than modic in nature. I have therefore repeated some of reply comments that I sent to Ana.

I think that you and Ana might be right when you say that the pain both referred and back could be mainly coming from the disk protusion.

The brief MRI report which was taken 2.5 years ago said,

' Scattered mild degenerative chages seen throughout. The most significant abnormal area is L2/L3. At this level there are early chages of spinal stenosis produced by a combination of factors. There is a small broad based  posterior disc prolapse. There is also evidence of posterior element hypertrophy. At this level, there is some potential evidence of neural compression in the left lateral recess by the herniated disc. No other significant abnormality is identified'.

I was so disappointed that the AB reatment did not make a significant difference and having been active all of my life and suddenly being curtailed from all physical activity was so frustrating and painful,  but you have and Ana have given me some hope of a treatment other than surgery.

Thank you for your time and understanding.

Regards,

Dafydd

   I'm sorry to hear that the full course of antibiotics didn't help. Back problems are really complicated, and all the possible ways to resolve them are quite the maze.

   But follow the advice of mastdoc ( the most knowledgeable, helpful and patient person on this blog ), and don't give up, keep reading this blog, and any other honest internet site ( beware of greedy quacks ), and check out some good books.

   Nevertheless, it is strange that so little research seems to be continuing that of Dr. Albert. Also, its strange that Dr. Albert now seems to be distancing herself from studies into curing Modic 1 pain, although I understand she did receive quite a bit of academic criticism.

   About myself, I don't think I have Modic 1 changes, but do have lower back pain for 7 years from a herniated disc at L5/S!, which over the years is improving with conservative care ( sitting still painful though ).

   In one of your first posts you said : " Ana, thank you for the information. i am going for my assessment this Friday and hopefully the modic changes are relevant. They look promising according to the Broadgate clinic in London after seeing one image." I live in Canada, where, like the U.S., they don't seem to give much importance to Modic 1 changes. So, please tell me, how does one get evaluated for Modic 1 changes ? mastdoc gave me lots of advice on this, but what is the way to get tested in the U.K ? How were you originaaly diagnosed for Modic 1 changes ? Like I said, here in Canada it seems to be ignored by the professionals. Perhaps its just not in the budget of our socialized Government Health care.

   Don't give up, and please stay in touch through this blog.

   William

I find it refreshing to see how individuals who take an intellectual approach to their condition become so knowledgable.

That's a good question. For those of us who live in locations non favorable to the antibiotic protocol, it is difficult to understand and even more difficult to imagine going to a local MAST center.

I think its more reluctance to think outside the box for practitioners. As far as governments, they could save a lot of money using the protocol over surgery or more expensive drugs/treatments.

Anyway, I thought I would relate some recent experience as a sufferer of Modic 1, I'll try not to be too doctorish. William is very familiar with my history. My first trial of Augmentin - double dose, lasted 20 days before having an atypical reaction. Dr, Albert had urged me to persevere, however, I could not. I think she is still mad at me.

So, I figured I would wait till summer to try again, perhaps monitoring liver and kidney profiles. Bad move... tore shoulder apart and had to have surgery. MRI showed torn subscapularis and biceps tendon, So, now I have 2 screws holding these tendons in place and also had acromioplasty. Ouch! Still ouch at 5 months! The MRI also showed the head of the humerous had inflammation in the bone. Like Modic changes in the shoulder, but no destruction - still very painful.

Perhaps from the rather potent and dangerous anti-inflammatory I took for 5 days post surgery due to the bone inflammation, my back pain had eased up. Good thing, I had to sleep in a recliner and had one arm and my core muscles to get out and about.

The pain relief in my back had lasted through rehab, which I rapidly progressed with only 2 days of experiencing any lumbar microfractures, until last month, when they progressed me to lifting heavy weights. Needless to say, that was my last visit and the straining, with a large increase in intrathecal pressure brought it back with a vengeance.

Yes, I told them, even showed them my MRI, but the physcial therapists were not familiar with modic changes. If it hurts, exercise it! That's the gold standard afterall when it comes to back pain, right? Recommended by all the guidelines! Well, I should have known better, so my bad.

Pain, not just mainly at L5/S1 - the most advanced location of erosion, but at every level in my lumbar spine, including my neck. Multiple level Modic 1. Felt like I was developing ankylosing spondylitis. Extremely painful and quite distressing.

Well, I am not ready for the second Augmentin trial yet. What to do? The pain seemed to be increasing to rediculous levels each day! Painkillers?

Because, Augmentin or Bioclavid is not in the tetracycline family, it was chosen as the antibiotic of choice for the double blind study. Tetracycline related antibiotics reduce tnf-alpha, an inflammatory chemical that is a fertilizer for the ingrowth of sensitive nerve fibers, nerves that feel pain and microfractures. The Augmentin would produce strictly antibiotic results for the trial. It is often used for spinal infections post surgery.

Anyway, I started taking Bactin, an antibiotic, and the results have been rapid relief in a matter of days. Not cured, just relief. About 50% now - day 2. This is not going to kill the bacteria, just reduce tnf-alpha, thus pain, inflammation and stiffness.

This is similar to Sulfasalazine, which has been used to treat arthritis for many years. Combination of antibiotic (bactin) and aspirin. I will probably get criticized for this, so many are anti-antibiotic, however, with multi-level Modic 1, type 2 changes in the lumbar and cervical spine and a severe exacerbation, I had no other reasonable choice. You can argue with my clinical reasoning, but you will lose! A bit of Sheldon in all of us! Still back pain, neck pain and headaches, but much improved so far.

So, perhaps this helps those with a non-linear path regarding the MAST protocol. Maybe a trial for Dafydd? Anyway, sorry for such long posts lately, if your still awake to read this far.

This is a wonderful site for information, personal experience and exchanging ideas. William, this probably catches us up, as far as me, since we last communicated personally. All the best to you and yours!

Hope everyone has a nice holiday this season. Don't be surprised Santa, all I want for Christmas is some antibiotics!

After 2.5 years of various private and NHS conventional physiotherapy treatments, and no improvements in the back and refrerred pain in the left hand hip side I decided to pay for my own MRI scan. The brief report said '

Scattered mild degenerative chages seen throughout. The most significant abnormal area is L2/L3. At this level there are early chages of spinal stenosis produced by a combination of factors. There is a small broad based  posterior disc prolapse. There is also evidence of posterior element hypertrophy. At this level, there is some potential evidence of neural compression in the left lateral recess by the herniated disc. No other significant abnormality is identified'.

I happen to come across an article about Dr Albert's work and noticed that there were white circular patches on my scans at the L2/ L3 vertebrae. I sent one image to Dr Albert who said that they looked like modic 1 changes and would qualify for the AB treatment in her clinic in Denmark. She also suggested that I try the Broadgate clinic in London who were mast trained. I visited the Broadgate clinic who agreed that the changes were modic 1 and tried the AB treatment but as you know it unfortunately did not help. There are various mast trained centres in the UK.

I manage the pain to a certain extent by taking 200mg ibuprofen most nights, but would obviously wish for a more permanent solution to the pain.

I wish you well and hope you are having a peaceful and happy time at Christmas.

Kind Regards,

Dafydd

There may have been changes with the antibiotics if Modic 1 was present, but not the main cause of the pain. Upper lumbar problems typicaly refer pain to the lower back, hip and sometimes groin.

Modic 1 pain would ten to be deep in the back with pain when bending forward; bad in the morning, better late morning/early afternoon, worse in the late afternoon and much worse at night. I'm sure they would have screened you for this symptom profile and made sure your MRI was done on a low field unit, or they are guessing.

It is unusual for modic changes to start in the upper lumbar region. Perhaps there was an injury. Regardless, a prolapse would indicate the nuclear material outside the disc. This could be inflammatory. I'm surprised the MRI report would not have at least indicated "reactive endplate changes", as Modic changes start with the endplate.

The prolapse should have a long term effect to corticosteriod epidural injections. If Modic changes are responsible, the effect would be short term or very little result.

Regardless of if the Modic changes are infectious or structural, they should respond to a tnf-alpha inhibitor. Please see my response to William's post for a suggestion, specifically addressed to you.

 All the best!

I feel really good. It might be the conjunction of the two treatments (AB plus the one at Clinica Nishimura). I remember that before the AB treatment I had pain if the L4/L5 area in my back was pressed. I do not feel that anymore. I believe you should feel much better if you do the same treatment I did. I am from Lisbon, and as I wrote I went to clinica Nishimura in Brejos Azeitao (about 25 km from Lisbon. Its easy to Google, worth a visit to the site). Dr. Nishimura has a vast knowledge of the spine (combines occidental and oriental medicine) and his treatments are excellent for degenerated spine, hernias or protrusions. In my opinion the pain comes from several factors: protrusions, hernias, degeneration, modic changes, etc. Dr. Nishimura used to practice in São Paulo, Brazil but he moved to Portugal 2 years ago and in this period he has almost 2000 patients. The treatment does not include other chemical rather than B12 injections on the spine area.

Here is a translation of my MRI. I think it is worse than yours. I have problems at three levels:

“L4/L5: Ostheocondrosis of mixed type in the end plates adjacent to L4-L5 (MODIC I and II). Degenerative discopathy. Reduction of height and normal stage of hydration of the disk which is diffusely procident. Stenosis of the central spinal canal at that level, as well as the sub-articular recesses, although this aspect is left predominant.

L3-L4: Degenerative discophaty in L3-L4 and L5-S1, although of moderate comparative degree and without marked degenerative stenosis of the spine canal associated. Small focal protrusion of the left disc contour.

L5/S1:Small protrusion to the right, contacts the emergency of S1 root to the right. Endplates arthrosis."

I went to see Dr. Hanne in Odense, DK, because I had Modic changes and a huge back pain which did not improve with NSAI and muscle relaxants. Doctors in Portugal do not acknowledge the AB treatment for back pain and one told me if he was to prescribe such quantity of AB to the same patient he would have to respond to some board.

Good luck.

Ana

Following your advise I will go to Nishimura clinic on January, the 12th, for my first consultation. I will keep you informed about the results. Meanwhile, I did a DW-MRI, that showed a claw sign on the DW image. Apparently there is strong scientific evidence that this means the Modic Change is mechanical and not infectious originated. When I inform Dr. Albert about this I was amazed when she seemed surprised by this. She basically said that there is no correlation between a claw sign and an infectious Modic change! Well, I sent her this DW-MRI and she will evaluate it in order to define the best treatment option for my particular case. In the meantime I will start Dr. Nishimura's treatment and hope things start to look brighter for my back pain.

Thanks for your advise.

The disc prolapse and vertebrae movement at L2/L3  as you suggested does cause me to have chronic referred pain to the lower back, hip and groin area. I also think that the damage was done many years ago by falling heavily on my back onto a tiled gym  floor while playing football!

The MRI scan and report was from my local hospital and perhaps that it why there was no reference to modic changes. This was the scan that the Broadgate clinic looked at in order to determine if I could try the AB treatment.

Thank you for your reference to the use of a tnf-alpha inhibitor such as Bactin. Could you please give me some more information about Bactin, as my daughter is a pharmacist and might have come across it under another name in the UK?

Hope that your Christmas was peaceful and enjoyable as well.

thank you

Dafydd

The MRI scan and report was done by my local hospital 

I took this for 4 days; 800 mg Sulfamethoxazole, 2x day for 2 days, 1x day for 2 days. When things calmed down, and it was getting very bad, I stopped. Not what your doctor would typically recommend. I know someone who takes Bactrim, 800 mg every day. If he does not, he has pain. Taking it keeps his back pain in control. Not every doctor will comply with this. It is still an antibiotic, so the general precautions should be taken.

I am trying to refrain from using it daily. Since I stopped, the pain is slightly worse, but not near as bad. However, should it return at levels during the recent exacerbation, I would not hesistate to take the Sulfamethoxazole again, and it looks like I might have to. The combination with Trimethoprim is fine and, technically, is the Bactrim; but I had the Sulfamethoxazole on hand and it was very helpful.

My initial trial of the Augmentin/Bioclavid double dose lasted 20 days. Atypical reaction and had to stop. Will look to another trial at single dose or Amoxicillin alone. Will probably need to monitor kidney and/or liver profiles. I am very sensitive to antibiotics, however, the Sulfamethoxazole is preventing the use of serious pain killers an/or epidural injections, as recommended by my Orthopedist.

So, I would use to tolerance and based on your specific response. I hope it helps!

Just a note, make sure there is no hip problem like bursitis and/or arthritis, as this can cause similar symptoms. I have this as well. A comorbid condition with the Modic changes.

All the best!

Hi mft,

I think Dr Nishimura will help you.

Regarding the dw-mri, I think that Dr Albert should know about that. If she does not it is because it not relevant or conclusive. When I consulted her, I showed her my blood work. I did the most extensive blood analysis possible. My results were excellent, including ESR (erythrocyte sedimentation rate) and CRP (c-reactive protein). She told me that before they did the AB study which lead to the paper, they spent thousands on blood work of the elective patients and it was not conclusive. Before consulting Dr Albert, I went to see a orthopedist who is specialized in degenerated spine. He told me that he would prescribe AB for discitis/osteomyelytis, and patients who have that would present ERS and CRP values out of the range. I think the dw-mri would apply to these cases, maybe not to the infection with propionibacterium acnes.

Regards,

Ana

https://patient.info/forums/discuss/should-dwmri-be-routinely-recommended-for-modic-1-changes--336650