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There has been a great deal of interest generated by a recent paper published and promoted at an event at the Royal Society of Medicine on May 7th. The paper that was published looked at back pain being treated by antibiotics. I have had the opportunity to look not only at the research advertised, but also the related work over the last five years.
Back pain is a highly complex condition. The possible causes are multiple and no two patients are ever the same. The original cause of the pain can be related to one of many possible areas: a problem in the intervertebral disc, one or many of the joints in the spine, a muscle or muscle groups, the bones of the spine, the nerves or a ligament.
Once the pain becomes chronic, the way in which that original problem is processed and interpreted (by the brain) changes. The way that the pain signal is altered is governed by genetics and the alteration in the processing can occur in the nerves, the spinal cord and in the hind and fore brain.
The research into antibiotics has concentrated on patients with intervertebral disc-related pain where the bone above and below the disc has become swollen. This can be seen on MRI and is not especially common. The changes seen are called MODIC type1. This is thought to be inflammation of the bones, possibly caused by a low grade infection.
The study recruited 347 patients who had had back pain for over 6 months. 60% of these patients did not meet the criteria and were excluded. The remaining 162 patients were randomised to receive either a placebo (a treatment with no effect) or 100 days of an antibiotic. It appears as if the patients receiving the antibiotics did better than those who received the placebo. It is however, wise to treat the results of any single study with caution.
My advice to a back pain sufferer would be;
1. If you have back pain, take pain killers in the first instance. Many people recover within a relatively short period of time.
2. If the situation does not improve within a matter of weeks, I would suggest a short course of physiotherapy. If your condition is not improving within 2 months, further advice should be sought.
3. A consultation with a Pain Management Consultant will give a working diagnosis. During that consultation, you would be asked for a full history of the condition and undergo an examination and MRI scan. It may be now that antibiotic treatment could be considered but it is far more likely that other drugs, lifestyle changes or injection therapy would be more appropriate.
Patients who have suffered with back pain for more than 6 months, who have excluded other more obvious causes of their pain, who have had more important compounding factors dealt with, and who have clear type1 Modic changes on their MRI, may be offered 100 days of antibiotic therapy.
Dr Mark Alexander-Williams, Pain Management Consultant, May 28th 2013
This article was written by Dr Mark Alexander Williams, Pain Management Consultant at The Chelmsford. The Chelmsford (Aspen Healthcare) does not take any responsibility for the content of this article.