Antibiotics – A Cure For Chronic Lower Back Pain?

04 Jul 2013

In the media recently there has been a storm about how antibiotics is the new upcoming therapy chronic lower back pain sufferers. The Guardian newspaperwents as far as to state:

Anti-biotics could cure 40% of chronic back pain patients

On face value this is a remarkable discovery indeed and one that could change the entire management of people who suffer with lower back pain. But in reality is this actually the case?

The answer is in fact probably not. The type of back pain that this modic antibiotic spine therapy (MAST) can treat is very specific. The actual type of back pain is known as modic-related back pain (MBRP) and according to the numbers that are quoted in the study constitutes 20 to 40% of all chronic lower back pain sufferers. However, the study has recently come under scrutiny as the authors of the study failed to declare their links with a company that certifies doctors in antibiotic therapy. This means the study as at a large risk of bias and the numbers quoted might well be not as accurate as first thought.

Even though the study is at a high risk of bias if it is assumed that the failing to declare a link was a genuine mistake then the course of treatment would involve taking antibiotics three times a day for one hundred days. This has apparently been shown to be effective in approximately 80% of cases. This then means that 16% of all chronic lower back pain sufferers can benefit from treatment and 84% will not benefit, if the numbers quoted are accurate. This is by no means a small percentage but in the same breath it is not quite as high as suggested.

However, then comes the risk of the treatment. Unfortunately we are currently living in a society where antibiotics are over prescribed and bacterial resistance is getting stronger and stronger every day. For this type of treatment it greatly increases the risk of bacterial resistance becoming even stronger. The course of treatment is very long and in the authors own words 20% of the patients will have no improvement from therapy. Out of 10 patients on MAST treatment this would mean 600 antibiotics will have been used to no avail thus increasing the chances of increasing bacterial resistance.

In conclusion, I feel this is a breakthrough for the treatment of a small percentage of people who suffer with back pain if the numbers quoted are reliable. I would hope more independent studies would be performed before this was rolled out to avoid the risk of increasing bacterial resistance and causing more problems for the future.

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