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Antibiotics to cure some types of back pain


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Curing some types of back pain through infection control? What an interesting concept, and considering the vast amounts of money back pain cost the economy through time off, medical expenses and disability payments, the ability to cure backpain with a simple and effective course of treatment is a godsend that could save millions if not billions of dollars:


Antibiotics could cure 40% of chronic back pain patients
Scientists hail medical breakthrough by which half a million UK sufferers could avoid major surgery and take antibiotics instead

Ian Sample, science correspondent
guardian.co.uk, Tuesday 7 May 2013 09.30 BST

Scientists in Denmark found that 20% to 40% of chronic lower back pain was caused by bacterial infections. Photograph: Alamy
Up to 40% of patients with chronic back pain could be cured with a course of antibiotics rather than surgery, in a medical breakthrough that one spinal surgeon says is worthy of a Nobel prize.

Surgeons in the UK and elsewhere are reviewing how they treat patients with chronic back pain after scientists discovered that many of the worst cases were due to bacterial infections.

The shock finding means that scores of patients with unrelenting lower back pain will no longer face major operations but can instead be cured with courses of antibiotics costing around £114.

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.

Hamlyn recently operated on rugby player Tom Croft, who was called up for the British and Irish Lions summer tour last month after missing most of the season with a broken neck.

Specialists who deal with back pain have long known that infections are sometimes to blame, but these cases were thought to be exceptional. That thinking has been overturned by scientists at the University of Southern Denmark who found that 20% to 40% of chronic lower back pain was caused by bacterial infections.

In Britain today, around 4 million people can expect to suffer from chronic lower back pain at some point in their lives. The latest work suggests that more than half a million of them would benefit from antibiotics.

"This will not help people with normal back pain, those with acute, or sub-acute pain – only those with chronic lower back pain," Dr Hanne Albert, of the Danish research team, told the Guardian. "These are people who live a life on the edge because they are so handicapped with pain. We are returning them to a form of normality they would never have expected."

Claus Manniche, a senior researcher in the group, said the discovery was the culmination of 10 years of hard work. "It's been tough. There have been ups and downs. This is one those questions that a lot of our colleagues did not understand at the beginning. To find bacteria really confronts all we have thought up to this date as back pain researchers," he said.

The Danish team describe their work in two papers published in the European Spine Journal. In the first report, they explain how bacterial infections inside slipped discs can cause painful inflammation and tiny fractures in the surrounding vertebrae.

Working with doctors in Birmingham, the Danish team examined tissue removed from patients for signs of infection. Nearly half tested positive, and of these, more than 80% carried bugs called Propionibacterium acnes.

The microbes are better known for causing acne. They lurk around hair roots and in the crevices in our teeth, but can get into the bloodstream during tooth brushing. Normally they cause no harm, but the situation may change when a person suffers a slipped disc. To heal the damage, the body grows small blood vessels into the disc. Rather than helping, though, they ferry bacteria inside, where they grow and cause serious inflammation and damage to neighbouring vertebrae that shows up on an MRI scan.

In the second paper, the scientists proved they could cure chronic back pain with a 100-day course of antibiotics. In a randomised trial, the drugs reduced pain in 80% of patients who had suffered for more than six months and had signs of damaged vertebra under MRI scans.

Albert stressed that antibiotics would not work for all back pain. Over-use of the drugs could lead to more antibiotic-resistant bacteria, which are already a major problem in hospitals. But she also warned that many patients will be having ineffective surgery instead of antibiotics that could alleviate their pain.

"We have to spread the word to the public, and to educate the clinicians, so the right people get the right treatment, and in five years' time are not having unnecessary surgery," she said.

Hamlyn said future research should aim to increase the number of patients that respond to antibiotics, and speed up the time it takes them to feel an improvement, perhaps by using more targeted drugs.

The NHS spends £480m on spinal surgery each year, the majority of which is for back pain. A minor operation can fix a slipped disc, which happens when one of the soft cushions of tissue between the bones in the spine pops out and presses on nearby nerves. The surgeons simply cut off the protruding part of the disc. But patients who suffer pain all day and night can be offered major operations to fuse damaged vertebrae or have artificial discs implanted.

"It may be that we can save £250m from the NHS budget by doing away with unnecessary operations. The price of the antibiotic treatment is only £114. It is spectacularly different to surgery. I genuinely believe they deserve a Nobel prize," said Hamlyn. Other spinal surgeons have met Albert and are reviewing the procedures they offer for patients.
Key phrase " some back pain".

A very specific type of chronic pain that has a unique set of circumstances to develop the disease.

NOT the type of back pain I generally see in our military population.
Knowing from personal experience that back pain sucks, and mine is pretty managable at this point in time (although there are days). :(

It wouldn't help part of my back pain, which is the result of degenerative disc disease, but it could help with the pain from the bulging disc they identified if indeed there is some form of infection in there as well.
I had an infection that I was taking antibiotics for when I hurt my back. I had severe inflammation problems for years afterwards. Had to see specialists about it. This is very interesting.
I was at a conference on Lyme Disease of all things last year when something similar came up about how one of the IV antibiotics used to treat so called Post Lyme Syndrome actually has some effect in the brain in some of the receptors that deal with anxiety and pain perception, so might be of assistance in that regard as well...but the big thing, like anything in the medical field, is ACTUALLY READ THE STUDY - as RP noted, it may help a small subset of patients.  I'm not sending folks off for spinal biopsies and culture anytime soon.

Lyme is a bitch. I though it was gone for 6 years. When my Physio got intense for another injury I had joint pain and swelling along the course the infection took up my arm and into my shoulder. Even some of the same symptoms as it cleared up. I thought post Lyme was hypochondriacs with Google. Now I am not certain. This story makes me especially curious. I doubt it is a flare up though. It feels more like an old injury that didn't heal properly. This story definitely proves we should not be certain that our paradigm is correct.
Some of the symptoms can overlap common injuries from military service, among other things:

E.g. hearing problems/tinnitus; damage to joints; other symptoms that could be attributable to, and/or secondary to OSI-type injuries/presentations, etc.

We don't have testing facilities in Canada:

Untreated, it looks like it can have a very miserable impact on a person's quality of life.
Thanks for the support Thucydides.

I actually don't get people not knowing they have contracted Lyme. The tick bite turned into a bulls eye rash. Which in a few days became a large open wound that would not heal. Then the wound started to turn black. My lymph nodes swelled. I had terrible pain in my hand at night. My wife said I was biting it in my sleep. Then the joint pain in my shoulders and neck became unbearable. One of the lymph nodes turned purple and had a weird blood vessel pattern radiating from it. I then went to a Doc who prescribed 5 days of amoxicillin. I made him double it to ten days(which is now the treatment standard) and took Flagyl as well on my own.

Lyme and syphilis are both spirochetes, a rather unique phylum that is characterized by a corkscrew shape and an ability to coil and lie dormant when stressed. This corkscrew shape can aid their motility in burrowing into tissue and crossing the blood brain barrier. Once Lyme crosses that barrier amoxicillin cannot reach it. So as a precaution I took Flagyl concurrently since it can cross that barrier and is rather effective on Lyme's cousin syphilis. The risk from antibiotics was minimal compared to how fucked you are if Lyme reaches your central nervous system.