Why are patients asking for Anti-biotics for their Back pain?
Reference:Albert HB, et al. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J. 2013 Apr;22(4):697-707.
Following a disc herniation, blood capillaries grow into the disc in order to nourish and heal the injured area. Sometimes the blood capillaries may introduce the bacteria called Proprione, which is the same bacteria that causes acne. It is theorized that this bacteria may result in a chronic infection, which may explain the presence of vertebral body edema in some patients with chronic LBP.
To investigate the bacteria theory, researchers in Denmark recruited 162 patients with a history of a herniated disc, chronic LBP, and MRI confirmed bone edema for this study.
In this double blinded and randomized trial the patients received either 100 days of antibiotic treatment(amoxicillin) or 100 days of an identical placebo.
Basic Result: Compared to the placebo group, the patients receiving antibiotics had statistically significant improvements in pain and functional scores at 100 days and at one-year follow-up.
Strange Result: The strange part of the study was that 80% of the patients on the antibiotics had significantly less LBP, however the placebo group showed no improvement in any of the measured outcomes, whereas normally in other studies placebo groups show at least some improvement.
The problem with this study is that it is for now one of a kind and not yet replicated. However the public and the media are so enthusiastic to find a “back pain cure” that this one study is getting more credit than it deserves.
If your patient has heard of this study through the media and asks you, “Should I take antibiotics?”
Tell them that this was a one off study and that the subjects had proven vertebral body edema on their MRI, so it was a very selective population. Also taking antibiotics for 100 days is not a benign thing, it has consequences!
Posted on: September 26, 2013
Categories: Lumbar Spine