Antibiotics for Back Pain?
Don’t worry about seeing your Chiropractor or Physio.
You just need antibiotics for your back pain.
You may have noticed in the news last week it was reported that up to 40 per cent of chronic back pain could be cured by simply popping an antibiotic pill, startling new research shows.
Danish researchers have discovered that in two out of five people with chronic lower back pain, an infection in the discs between their vertebrae contributes to their pain.
The doctors involved in the study treated their patients with a common antibiotic, augmentin, for 100 days and found 80 per cent of them felt much less pain and took fewer sick days.
British experts have hailed the breakthrough as historic and claim up to half of all surgery for back pain could now be replaced with an antibiotic regime.
Australian National University infectious diseases expert Associate Professor Sanjaya Senanayake says the research was conducted as a randomised control trial and is likely to “generate a lot of discussion” among medicos.
The discovery is being compared to the breakthrough research that found it was a bacteria that was responsible for stomach ulcers.
Professor Sanjaya Senanayake said the treatment is only suitable for patients with slipped discs, where the disc that normally cushions the vertebrae is pushed out.
Inflammation develops around the slipped disc and one theory is that if the patient has any bacteria in their bloodstream it might end up at this area of inflammation and thrive there, Professor Senanayake said.
The bacteria called Propionibacterium acnes that the Danish scientists found in people’s backs are better known for causing acne, they are harboured in the mouth and can get into the bloodstream during tooth brushing.
Some patients in the trials had to stop taking the antibiotics because they suffered side effects from the pills.The research was reported in the European Spine Journal.
According to the Guardian
One of the UK’s most eminent spinal surgeons said the discovery was the greatest he had witnessed in his professional life, and that its impact on medicine was worthy of a Nobel prize.
“This is vast. We are talking about probably half of all spinal surgery for back pain being replaced by taking antibiotics,” said Peter Hamlyn, a consultant neurological and spinal surgeon at University College London hospital.
Ok. Kind of troubles me that a Professor would talk about a slipped disc.
Discs can tear, protrude or herniate, but they definitely do not slip.
Perhaps the professor was misquoted by the paper. Need to give Sanjaya the benefit of the doubt.
Nonetheless this is interesting stuff. Is it worth a Nobel Prize? I am not sure.
The big question here is which comes first – the chicken or the egg?
Is the bacterial infection secondary to disc pathology or a primary driver of the original disc injury?
Disc injuries are quite complex.
They usually involve functional instability of the spine with compensatory changes in vertebral motion, blood flow, cerebral spinal fluid dynamics, neurological sequelae and of course, myopathology (muscle spasm and damage).
As discs have a very poor blood supply, any tissue that is damaged and necrotic is subject to secondary bacterial infection.
It could be the acne bacteria. It could be mycoplasma. A Rickettsia virus. Or even a Michael Douglas favourite- a herpes virus.
So I think the antibiotics could be a little hit or miss. If the infection is bacterial then the intervention will work. If it is viral – which is probably more likely – then the antibiotics will not work.
The entrance point for the bacteria is the new capillary system surrounding nucleus material in a herniated disc.
Unless you have a new herniation, there is no way that the bacteria can enter the disc, because the disc is enclosed and has no blood vessels inside it. Therefore the bacteria is unable to enter and consequently infect a normal disc.
But even if you are treating the secondary infection, what is being done to help the disc repair?
Electroacupuncture located at the injured vertebral segments (i.e. either side of the disc injury) can help promote blood flow to the disc and assist in the recovery of the disc injury.
Specifically placed electroacupuncture with around 300 to 400 hz stimulation will also cause a neurological damping (called gate theory) of pains and facilitate an endorphin release.
If you don’t have access to this type of work, then consider a good TENS unit, specifically placed to promote some blood flow and manage your pain.
The average course of care the antibiotics in these trials was 100 days.
Obviously this is a very long time to be on antibiotics, and only suitable to patients with very specific changes.
In particular patients had to be identified with type one ‘Modic” changes in the vertebral bodies next to the injured discs. Modic changes are bone oedema (swelling) in the vertebrae an cause pain in the lower back or neck.
Interestingly Modic changes can only be seen on MRI scans.
According to the authors;
Approximately 6% of the population suffer from back pain caused by Modic changes and approximately 35% – 40% of the patients who consult a specialist at Spine Centres have Modic changes.
As this specific back pain condition cannot be seen on spinal X-rays, many cases remain undiagnosed. However Modic changes can only be identified on MRI scans.
Another interesting development to this study was the pushing of so called “Mast certified doctors” who were the only ones to ensure successful treatment.
Whilst this was not pushed in the press releases; the open forums and chat rooms where used as a vehicle to promote a website to find ‘your nearest Mast certified doctor’….
To ensure that treatment is successful patients should consult a MAST certified doctor and/or therapist. Prolonged antibiotic therapy is not to be treated lightly. Only careful scrutiny will identify the patients who will benefit most. A certified doctor and/or therapist will review the patient’s medical history and recent MRI scans.
Thorough patient information is crucial as Modic changes reflect a complicated disease and in the different stages of recovery different advice is needed.
A MAST certified doctor and/or therapist are most able to guide patients towards better clinical results and a life that is free of pain.
Maybe I’m getting a little cynical here.
Without stating the obvious, antibiotics will not work for viral infections nor will they correct the underlying disc injury or altered vertebral motion dysfunction.
And I fear that this will cause a continuation of the rather ‘generous’ prescription of antibiotics that exists in this country.
Bear in mind too, that antibiotics significantly impact on gastrointestinal function. They effectively wipe out good bacterial cultures of the bowel which not only help you digest your food, but are instrumental in maintaining the lumen of the bowel (the integrity of the bowel wall and intestinal mucosa).
In most patients it can take up to a year to recover from a ‘normal’ course of antibiotics over 12 to 15 days. One hundred days is a completely different proposition.
Also, antibiotics contribute to dysbiosis and intestinal hyperpermeability; an inflammatory disorder of the bowel where toxins and faecal material passes through the endothelial cells of the lumen and into the abdominal cavity where they are picked up by the circulatory system.
This results chronic inflammatory changes around the entire body.
The more inflamed you are, over time the more back pain you will experience.
So if you are going to use antibiotics for your back pain, be careful. It appears they only work in specific cases.
Mitigate the damage to your gastrointestinal system by the use of an appropriate probiotic. There are many different types of probiotics that do different jobs. They can be found in the Spinal Centre store under the probiotic section.
If you like this article be sure to visit the Spinal Centre website at www.thespinalcentre.com.au and view more content by Dr. Hooper and the Spinal Rehabilitation Team.
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