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Antibiotics to treat low back pain

Discussion in 'Biomechanics, Sports and Foot orthoses' started by toomoon, May 10, 2013.

  1. toomoon

    toomoon Well-Known Member

    Members do not see these Ads. Sign Up.
    New research being hailed as "Nobel Prize worthy" uses antibiotics to treat low back pain. Suggested to be effective in up to 40% of all chronic low back pain.
    Dr. Peter brukner shed light on the research at http://blogs.bmj.com/bjsm/2013/05/0...-subset-of-people-with-chronic-low-back-pain/
    it is important to note this therapy is recommended only for those individuals who have severe recalcitrant low back pain that would normally require surgery. the bacterium is treated with Augmentin, also used to treat acne, caused by the same bug.
  2. JasonR

    JasonR Member

    Thats Big. Type 1 Modic changes have been strongly associated with with a symptomatic spine, though I didnt believe they were as common as 40% in LBP sufferers. You wouldnt normally image (MR) for isolated LBP in the absence of trauma, peripheral symptoms etc unless you thought it might change your management- but now it might?
    I always thought of the nucleus as an isolated, avascular structure, though I see they describe vascular ingrowth as a potential delivery mechanism for the bug (sounds like other pathologies such as sick tendons?). I wonder if there are other systemic signs of inflammation? There is also growing press about 'meta-inflammation' as a driver of other previously thought of mechanical/ degenerative conditions, including osteo-arthritis. It seems the more you look, the more many chronic health conditions have in common.
  3. Paul Bowles

    Paul Bowles Well-Known Member

    Would be interesting to see the post surgical infection rates and cultures - I know that say culturing in adjacent bone is low..... Great read Thanks Simon.
  4. Sicknote

    Sicknote Active Member

    Antibiotics smash your gut flora, leaving you with the seeds of all manner of problems, one being susceptibility to candida, leaky gut syndrome & weakening of the immune system.

    They can also damage your liver: http://eyeopening.xomba.com/warning_antibiotics_can_damage_your_liver

    Antibiotics may work for low back pain, but at the same time they can potentially trigger other illnesses. I believe nature has a cure for everything. Even strengthening the muscles that stabilize the spine don't require any special equipment, you can do it with simple breath training.

    I would look into other avenues for curing the lower back.
  5. Paul Bowles

    Paul Bowles Well-Known Member

  6. David Wedemeyer

    David Wedemeyer Well-Known Member

    The most currrent acute or chronic LBP patient that I saw with modic changes had an infection and extruded nuclear material, we see these what almost never? This represents a small subset of LBP patients with prolapse and attendant bacterial infection, not the typical mechaincial LBP which are the majority. Sorry, antiobiotics are not a panacea for treating the myriad cause and presentations of LBP.
  7. Paul Bowles

    Paul Bowles Well-Known Member

    David did you read the articles Simon posted? I'm not a back specialist by any stretch of the imagination however it is thought provoking. I hate to throw the catch amongst the pidgeons however whilst we are talking about poorly vascularised stress areas of the body has anyone ever done a microscopy and culture from plantar fasciotomy? Just saying......
  8. David Wedemeyer

    David Wedemeyer Well-Known Member

    Paul I did in fact read the papers and the article. I have no issue with the research other than that of numbers and nomenclature, specifically the ambiguous term herniation. Herniation is a contained disk and that space is sterile normally so how are the bacteria finding their way to the disc? Brushing the teeth was suggested, not likely in all of these cases. So we are discussing prolapsed discs, a small subset of LBP patients statistically. These are surgical patients. You do see MC in these patients (but not large numbers with infection).

    The article however makes the statement that "Antibiotics could cure 40% of back pain patients". My comments simply mean that chronic LBP patients make up a smaller segment of LBP sufferers than the acute or subacute cases and that within that smaller group of chronic LBP patients there is a much smaller subset of cases with modic changes associated with bacterial infections. I believe that the Guardian article is premature and inaccurate and that antiobiotics are not a panacea for LBP. Not in the numbers they are suggesting.

    I believe that the authors of the study are trying to link MC I to infection but the biomechanical and biochemical explanations of MC endplate disruptions make much more sense than infection. When you view a great number of lumbar MRI's you rarely see infection, more common is degenerative disc and bone (MC) and most is traumatic and lifestyle or lack thereof :D

    I've been wrong before but we'll see...some more reading for the interested:

  9. toomoon

    toomoon Well-Known Member

    David.. I see your dilemma, and perhaps parts of the paper are poorly defined, but as I said in the original posting, the intent of this therapy is ONLY aimed at those cases of LBP that would, as a part of their natural history, progress to surgery. I stand by my original comment.. under these circumstances.. gimme the pill .. quick!
  10. David Wedemeyer

    David Wedemeyer Well-Known Member

    Simon I agree, if there is an infection I'd be the first to the pharmacist but let's keep in perspective how many cases of chronic LBP are actually offered surgery and the claims of the article. I'm not attacking you my friend, it is good research and poor reporting and none is your doing.


    P.S. Come to California and we can discuss this and something entirely more fascinating...
  11. toomoon

    toomoon Well-Known Member

    I will be there at some point for sure.. I will let you know. Interesting post script David. Wilbur and Orville Wright were my grandmother Amy Wright's first cousins!
  12. Footoomsh

    Footoomsh Active Member

    As someone who had crippling back pain for 16 years before surgery and leg pain ever since I am struggling with this notion that nature has a cure for everything. There is hardly a remedy, treatment, or exercise regime that I haven't tried to cure this affliction. So I'm sorry, but if they found out I was one who would be relieved with antibiotics, even knowing the risks you list above......... Give me the pills!!
  13. Paul Bowles

    Paul Bowles Well-Known Member

    Reading the article I dont believe there is much to find out Matt - its just a prolonged course of penecillin with clavulanic acid isn't it? Easy enough to get hold of and trial with little side effects - might help you out of the tough situation with your back you are in! Worth a thought anyhow!
  14. Footoomsh

    Footoomsh Active Member

    Very interesting stuff from a very different angle to the traditional. Thanks.
  15. Craig Payne

    Craig Payne Moderator

    Back pain study failed to disclose conflict of interest
    Full story
  16. toomoon

    toomoon Well-Known Member

    well.. whatdoyaknow??

    Shades of Andrew Wakefield.. not at all good..
  17. David Wedemeyer

    David Wedemeyer Well-Known Member

    I called this one guys. They're trying to fit a much broader group than the small subset of Chronic LBP patients with infection than exists to promote a drug or class of drugs.
  18. toomoon

    toomoon Well-Known Member

    you did David.. well done.. in Australia we have a saying.."if it looks like a turd and smells like a turd.. it is probably a turd'.. well spotted
  19. gavw

    gavw Active Member

  20. David Wedemeyer

    David Wedemeyer Well-Known Member

    That is ghastly, working with a marketing firm to hype your research? Look at me, look at me, I deserve a Nobel prize. Truly inappropriate in research.
  21. Paul Bowles

    Paul Bowles Well-Known Member

    ...and this is the problem in the world today. It happens in Podiatry as well where people in this country seem to think they don't need to declare conflicts of interest! I'm still not going to discount their research completely...yet, however it makes me think twice about it now.
  22. wdd

    wdd Well-Known Member

    I don' think I'll be showing this article to my brother-in-law.

    A few years ago OK fity years ago to be exact, he was about to sign for one of the top Scottish football clubs. You've guessed it. Out of nowhere, lower back pain. Eventually, goodbye disc and goodbye any prospects of playing professional footbalL

    "Hi Rog. Remember all these years ago when your dream went up in smoke? Great news. It could have been cured by a course of antibiotics costing half a crown".

    " %#£@§$$£!!!"

    "There's no need to be like that. I just thought you'd like to know".

    A couple of weeks ago I saw a programme on television where an ex- professional footballer, who is now a manager, was saying to one of his newly retired players that he would spend the rest of his life trying to kill the player in him.

    Is it easier or more difficult to 'kill the player' when it was a reality or when it was a narrowly missed dream?

    As my wife says, I need to get out more.

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