This one is a stunner. Better, if we know forty percent of cases are
because of this infection, it is already likely that the problem will
be even larger. This compares to the ulcer discovery three decades.
Chronic Back Pain is infection driven and thus curable.
The additional warning here is that joint injuries can create an
infection site that produces pain. How about arthritis? What if
chronic pain is generally driven by this easily inserted bacteria?
So it is not only about back pain but also about joint pain itself
Thay shoe has not obviously dropped yet, but that is where this is
going.
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
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.
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