Antibiotics as cure for back pain?

by Dr Rahul Seewal (Consultant Anaesthetist)—Recently, some newspapers commented that 4 out of 10 cases of back pain could be cured with cheap and affordable antibiotics.

Dr Rahul Seewal, Consultant Anaesthetist

6 June 2013

Recently, some newspapers commented that 4 out of 10 cases of back pain could be cured with cheap and affordable antibiotics.

This story was based on a research study published in a medical journal earlier in the year. My patients in the pain clinic have been asking me about this study and are usually surprised when I talk cautiously about the results.

In this month's blog, I shall try and explain what I make of this study.

How research works

In order to prove a scientific theory, we follow a strict process to gain evidence supporting our claims, which is then reviewed by scientific colleagues for accuracy. The process, called a randomised control trial, involves:

  1. Writing a hypothesis

    This is our theory that will be investigated in the study. In this case, the theories were:
    • a. Linking low back pain without a medical cause where there is evidence of excess fluid in the back, shown on an MRI scan.
    • b. Excess fluid in the back being caused by either infection or inflammation caused by bacteria commonly linked to acne.
    • c. The treatment by an antibiotic used for a range of conditions (eg co amoxiclav) for 3 months could reduce excess fluid and therefore low back pain.
    • d. Increasing the amount of antibiotics given could have an even better effect on back pain.
  2. Method of study

    After getting approval for the research to take place, patients aged 18–65 who had low back pain for more than 6 months and other back pain symptoms were randomly put into 4 groups.

    Group A (45 patients) received 1 tablet of antibiotic, Group B (36 patients) received 1 tablet of a fake medicine (called a placebo), group C (45 patients) received 2 tablets of antibiotics and group D (36 patients) received 2 tablets of placebo.

    If there was a significant difference to the health of patients in the groups taking antibiotics and the groups taking placebo then this would suggest the hypothesis, and treatment, works.
     
  3. The results

    The group on antibiotics had improved their back pain compared to those taking placebo. The improved results started 6–8 weeks after starting the treatment but some were as late as the end of treatment period. Results were measured through various questionnaires given to the patients to complete that compared the intensity of back pain, leg pain, days taken off work and the number of visits to the doctor.

My question marks around the study

The reduction of back pain is said to be because of the treatment of the acne bacteria even though the diagnosis wasn't confirmed by any bacteria samples.

In studies involving pain medicines, 20–30% of patients having placebo would react positively to treatment. In this study, there is no improvement in the placebo group which is very unusual.

1 in 5 patients had mild gastrointestinal side effects when under treatment. A review of the possible side effects of the antibiotics on patients should have been taken before the trial took place.

The study hypothesis makes assumptions based on the evidence of previous studies that indicate the presence of acne bacteria following back surgery. But surgery may not be the cause of the presence of bacteria.

The study is a new approach to address a common problem and its findings provide a good platform for further research. But the use of antibiotics now, without this further research, must be cautioned as it's not certain the treatment works and there is already an over reliance of common antibiotics.

I look forward to your comments.

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