Antibiotics cure 40 per cent of chronic back pain: study
Scientists have hailed a Danish medical breakthrough which suggests 40 per cent of people with chronic lower-back pain could avoid major surgery and take antibiotics instead to cure the condition.
Source: PM | Duration: 4min 30sec
TIM PALMER: It's one of the most debilitating forms of all forms of chronic pain. Sufferers of a lower back condition are often afflicted around the clock every day of their lives.
A new study published in the European Spine Journal may have an answer for almost half the people who do suffer chronic lower back pain. The Danish study has found that antibiotics rather than surgery could cure many patients with the symptoms. One British spinal surgeon says it's a medical breakthrough worthy of a Nobel Prize.
Alison Caldwell reports.
ALISON CALDWELL: The hospital costs in Australia for chronic back pain and slipped discs are around $500 million a year. There's a huge industry devoted to the bad back: physiotherapy, chiropractic, acupuncture and of course, surgery.
But could it be that too much surgery is going on needlessly, in as many as 40 per cent of cases? A new study in Denmark suggest perhaps that's the case.
Peter Wilde is the president of the Spine Society of Australia.
PETER WILDE: I'm immediately very interested to hear about the breakthrough research. For years I've treated patients with back pain, some with very severe symptoms and when I've investigated them with studies such as MRI scans, I've wondered whether there might not be another factor which is underpinning some of the pain these patients have.
ALISON CALDWELL: The Danish study examined 67 patients with chronic lower back pain, following disc herniation. The average age was 46 and 27 per cent of the patients were women.
The study confirms the findings of five previous studies which suggested that up to half of patients undergoing surgery for a first-time disc herniation have a bacterial infection. Of those who tested positive, more than 80 per cent carried bugs called Propionibacterium acnes, or microbes better known for causing acne.
They live in hair roots and the crevices of teeth and can get into the bloodstream during tooth brushing. They don't usually cause any trouble but they might when a person suffers a slipped disc.
The findings mean that scores of patients with unrelenting lower back pain may no longer have to face major operations but can instead be cured with a course of antibiotics over 100 days.
Dr Peter Wilde is an orthopaedic surgeon, he says he's always wondered about the links between infections and back pain.
PETER WILDE: The publication talks specifically about MRI changes that occur in adjacent vertebral disks after a patient has a lumbar discectomy. Now a lumbar discectomy is an operation which is done for a disk prolapse and for many years when surgeons have sent specimens to laboratories, a certain percentage of patients will grow a bacteria. And for many years surgeons have just put that down to contamination.
This group has documented vary carefully that in these patients they often get changes at the next disk, which means either one disk above or below, of changes which are quite curious on the MRI scan and that's referred to as a Modic one change and the contention that they putting is that these changes actually occur because of the bacterial infection and possibly this group if we could identify the group would respond to a regime of antibiotics.
ALISON CALDWELL: Would it be a revolution if that was proven to be the case?
PETER WILDE: Oh most definitely. If we could draw a link between bacterial infection of a disk and back pain then it would make perfect sense to treat those patients with antibiotics.
ALISON CALDWELL: One of the lead authors, Dr Hanne Albert from the University of Southern Denmark said the study would not help people with normal back pain or those with acute or subacute pain, only those with chronic lower back pain. She says with a course of antibiotics these people are being returned to a form of normality they would never have expected.
Dr Peter Wilde says more research is needed.
PETER WILDE: It's very interesting but I suspect that if bacteria do cause back pain it's only in a very small percentage of some patients and the next challenge if it is in fact true is to identify which back pain patients might be due to a bacterial infection and obviously if we can demonstrate that then antibiotics might help those patients.
ALISON CALDWELL: Dr Hanne Albert says the subgroup of patients who would benefit from the antibiotic treatment could be identified with an MRI scan, a physical examination and pain history. The people have chronic lower back pain and suffer from constant pain 24 hours a day, seven days a week.
The study has been published in the European Spine Journal.
TIM PALMER: That report from Alison Caldwell.