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Antibiotics 'could relieve back pain symptoms'
9th May 2013 - A course of antibiotics could relieve symptoms of chronic lower back pain for up to 40% of people, according to a new study.
Danish researchers say they have identified a link between many cases of back pain and infection from bacteria.
Some experts have questioned how many people are likely to benefit from this treatment, while others have cautioned that boosting antibiotic use in the face of increasing resistance could be counter-productive and lead to increasing prevalence of superbugs.
Back pain is a common condition, affecting about four out of five people at some point in their lives. Back pain is also the largest cause of absence from work in the UK.
Recommended treatments depend on how long patients have had the pain and how severe it is but include pain killers, hot or cold compresses, lifestyle changes, physiotherapy and keeping active. In extreme cases - where other treatments have failed - surgery may be carried out to remove part of a damaged disc.
The latest studies from the University of Southern Denmark build on previous research which shows that between 7% and 53% of patients with herniated discs have anaerobic microorganisms, predominantly the bacteria which give rise to acne. In these patients the bacteria entered the disc at the time it was herniated, or 'slipped'.
In the first study of 61 patients undergoing spinal surgery for lower back pain, the researchers found bacteria present in 46% of the slipped discs.
In a second study, the research team recruited 162 patients who had been living with lower back pain for more than six months following a slipped disc.
Half of the patients were given a 100-day course of antibiotic treatment, while the others received dummy medication.
After a one-year follow-up period, those who had received antibiotics were less likely to still have lower back pain and physical disability.
They were also less likely to have leg pain and to have taken days off work because of their back.
The researchers estimate that approximately 35-40% of long-term back pain sufferers experience excess fluid in the spinal vertebrae and could potentially benefit from this type of treatment in the future.
The findings are published in the European Spine Journal.
'Not a cure'
Media reports that antibiotics could be a cure for back pain has alarmed John O'Dowd, a consultant spinal surgeon and president of the British Society for Back Pain Research. He tells us: "Unless you've had a disc herniation ... I don't think you should be getting too excited, and I don't think this is going to be a treatment for you."
He adds: "I think this is another useful building block of evidence but I don't think it's either a cure or the answer to back pain."
A spokesman for Arthritis Research UK comments in a statement that the findings were interesting, but added that "they may encourage more and more patients who would not benefit from such treatment to demand antibiotics from their GP as a result".
Laura Piddock, professor of microbiology at the University of Birmingham, says the findings need to be viewed carefully. "I recommend that until more evidence is available that physicians treating patients with back pain take the appropriate specimens to confirm bacterial infection," she tells us by email. "Only when this has been carried out should antibiotics be started.
"Due to the back pain being experienced by many people, the empirical use of antibiotics should be avoided and GPs should refer their patients to a specialist."