Colchicine in The Treatment of Acute Low Back Pain

Colchicine has been regarded by some as the most powerful anti-inflammatory agent known to man. The beneficial effects of colchicine in the treatment of gout are apparently secondary to its ability to inhibit both the metabolic and phagocytic activity and migration of granulocytes. Colchicine's inhibition of the release of histamine containing granules from mast cells is also believed secondary to its interference with granule transportation by the microtubular system. While beneficial in the treatment of the crystal-induced inflammation observed in gout and pseudogout, colchicine is only occasionally effective in the treatment of other types of arthritides (arthritis).

Resistant Disc Disorders
Over the past 30 years, Rask has treated thousands of patients with resistant disc disorders with oral and intravenous colchicine and has noted a 90-95% improvement rate. Since 1979, he has published the results of his uncontrolled studies, some involving up to 500 patients, who have suggested significant therapeutic benefits from colchicine therapy with fewer adverse effects than typically associated with the use of aspirin.

In a 1985 double blind study of 39 patients with low back pain of at least two months duration, Meek compared combined intravenous and oral colchicine treatment with placebo. Patients in the treatment group received colchicine .6-mg orally b.i.d. (twice a day) for 14 days and one-mg IV (intravenous) on days one, four and eight of the 14 day study period.

Adverse Effects
While no real effect from placebo administration was observed, the treatment group demonstrated significant improvements in pain, weakness, leg raising limitations, and muscle spasm. Adverse effects from colchicine administration were documented in only one patient in the form of a burn at the IV site. In a double blind study of oral colchicine in the treatment of low back pain, Schnebel and Simmons compared oral colchicine with placebo in 34 patients with low back symptoms of less than three months duration. Over the 12-week study period, both groups of patients continued in a comprehensive physical therapy program and were administered NSAIDs and muscle relaxants. No significant differences in therapeutic response were noted between the treatment and placebo groups, but an increased number of adverse effects, mainly diarrhea and vomiting, were observed in the colchicine group. This study has several limitations, including a small sample size, multiple etiologies of low back pain, poor patient compliance, and the use of concomitant treatments.

Contraindications
Colchicine use is contraindicated those patients with serious gastrointestinal, renal, hepatic or cardiac disease. Colchicine can also harm the fetus when used during pregnancy. When administered intravenously for the treatment of an acute gouty attack, the total dosage over the first 24-hours should not exceed four milligrams, as greater cumulative dosages have been associated with multiple organ failure and death.

Abdominal pain, nausea, vomiting, and diarrhea, are typically the earliest and most common adverse effects associated with colchicine over dosage. These gastrointestinal side effects can be almost entirely avoided with intravenous use. Colchicine has also been noted to cause a transient leukopenia (abnormal decrease in the number of white blood cells), which is soon replaced with a leukocytosis (abnormal increase in the number of white blood cells). Myopathy and neuropathy have been noted in patients with impaired renal function receiving colchicine treatment.

Colchicine and Low Back Pain
The use of colchicine in the treatment of the acute low back pain patient is not commonly practiced. While some practitioners have found colchicine effective in this patient population, others have not. Further investigation in this area is needed before colchicine use can be recommended for the low back pain patient. These studies may be helpful in further defining colchicine's place among other available anti-inflammatory and analgesic agents.

Reference:
Malanga GA, et al. Pharmacologic Treatment of Low Back Pain. In Physical Medicine and Rehabilitation State of the Art Reviews, Philadelphia, Hanley and Belfus Vol.13, No.3, October, 1999