Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor George Peat, Sheffield Hallam University, UK
- Second opponent: Professor Mari Hoff, Norwegian University of Science and Technology, Trondheim
- Third member and chair of the evaluation committee: Professor Angelika Sorteberg, University of Oslo
Chair of the Defence
Professor Mathias Toft, University of Oslo
Principal Supervisor
Professor II John-Anker Zwart, University of Oslo
Summary
Chronic low back pain is a common and disabling condition. The condition has wide-ranging impacts on individuals, families, health and social care systems. Nonetheless, the underlying cause remains unclear for most cases. In some patients, changes in the vertebrae visible on MRI known as Modic changes have been suggested as a potential source of pain. Inflammation has been proposed as a potential underlying mechanism, but treatment options are limited, and evidence is sparse.
This thesis aimed to investigate the effectiveness of a targeted anti-inflammatory treatment in patients with chronic low back pain with Modic changes, and to examine systemic inflammatory markers. The project included a randomized placebo-controlled trial and biochemical analysis of inflammatory cytokines in blood samples.
To investigate whether targeted anti-inflammatory medication is a new treatment option for this patient group, the multi center randomized, triple-blind, placebo-controlled BackToBasic-trial was conducted. Participants were randomly assigned to receive the TNF-inhibiting drug infliximab or placebo. Outcomes were measured after 5 months, and included disability, pain, and quality of life. Results showed no significant difference between the treatment and placebo groups. Infliximab did not reduce pain or improve function.
However, blood analyses revealed elevated levels of inflammatory proteins in this patient group compared to healthy controls and pointed to the cytokine MIF as a potential biomarker. Inflammatory markers remained stable over time, indicating a persistent inflammatory response.
In conclusion, while infliximab proved ineffective for this patient group, the findings support the theory that inflammation may contribute to the pathogenesis of chronic low back pain with Modic changes. The relevance of TNF is questioned, and the results underscore the need for further studies into alternative inflammatory pathways and tailored treatments.
Additional information
Contact the research support staff.