The efficacy of a glial inhibitor, minocycline, for preventing persistent pain after lumbar discectomy: a randomized, double-blind, controlled study
Related Experiment Video
Updated: May 11, 2026
Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation
Published on: April 7, 2023
Valéria Martinez1, Barbara Szekely, Jean Lemarié
1Department of Anesthesiology, Assistance Publique Hôpitaux de Paris, Hôpital Raymond Poincaré, Garches, France. valeria.martinez@rpc.aphp.fr
Abstract:
Minocycline strongly inhibits microglial activation, which contributes to central sensitization, a major mechanism underlying chronic pain development. We hypothesized that the perioperative administration of minocycline might decrease persistent pain after lumbar discectomy. We randomly assigned 100 patients undergoing scheduled lumbar discectomy to placebo and minocycline groups. The minocycline group received 100mg minocycline orally, twice daily, beginning the evening before surgery and continuing for 8 days. The primary outcome was the change in lower limb pain intensity at rest between baseline and 3 months. Secondary outcomes were pain intensity on movement, the incidence of persistent pain and chronic neuropathic pain, back pain intensity at rest and on movement, and changes in Neuropathic Pain Symptom Inventory, Brief Pain Inventory, and Roland-Morris scores at 3 months. An intention-to-treat analysis was performed for patients assessed from the day before surgery to 3 months. The decrease in lower limb pain intensity was similar in the placebo and minocycline groups, both at rest -1.7 ± 1.6 vs -2.3 ± 2.4 and on movement -2.5 ± 2.1 vs -3.4 ± 2.9. The incidence and intensity of neuropathic pain and functional scores did not differ between the minocycline and placebo groups. Exploratory analysis suggested that minocycline might be effective in a subgroup of patients with predominantly deep spontaneous pain at baseline. Perioperative minocycline administration for 8 days does not improve persistent pain after lumbar discectomy.
Insights
Perioperative minocycline did not reduce persistent pain after lumbar discectomy. This antibiotic, which inhibits microglial activation, showed no significant benefit in reducing lower limb or back pain intensity in patients.
Area of Science:
- Neuroscience
- Pharmacology
- Pain Management
Background:
- Microglial activation contributes to central sensitization and chronic pain development.
- Minocycline is known to strongly inhibit microglial activation.
- Persistent pain after lumbar discectomy remains a significant clinical challenge.
Purpose of the Study:
- To investigate the efficacy of perioperative minocycline in reducing persistent pain following lumbar discectomy.
- To assess the impact of minocycline on pain intensity, neuropathic pain, and functional outcomes post-surgery.
Main Methods:
- A randomized, placebo-controlled trial involving 100 patients undergoing lumbar discectomy.
- Patients received either 100mg minocycline orally twice daily for 8 days or a placebo, starting the evening before surgery.
- Primary outcome was the change in lower limb pain intensity at rest from baseline to 3 months; secondary outcomes included pain on movement, neuropathic pain incidence, and functional scores.
Main Results:
- No significant difference in the decrease of lower limb pain intensity at rest or on movement was observed between the minocycline and placebo groups at 3 months.
- The incidence and intensity of neuropathic pain, as well as functional scores (Neuropathic Pain Symptom Inventory, Brief Pain Inventory, Roland-Morris), did not differ between groups.
- Exploratory analysis indicated a potential benefit in a subgroup with predominantly deep spontaneous pain at baseline.
Conclusions:
- Perioperative administration of minocycline for 8 days is not effective in improving persistent pain after lumbar discectomy.
- Current evidence does not support the use of minocycline for managing post-lumbar discectomy pain.
- Further research may be warranted for specific patient subgroups experiencing deep spontaneous pain.
