Is cure for back pain all it's cracked up to be?

If you are unfit, have poor posture or any kind of existing hip or knee problems, then they are best avoided.

If you are unfit, have poor posture or any kind of existing hip or knee problems, then they are best avoided.

Published May 8, 2013


London - Up to half a million patients in the UK with chronic lower-back pain may be suffering from an infection that can be treated with antibiotics, it has been claimed.

One surgeon said on Tuesday that the eye-catching theory is so revolutionary the man behind it should win the Nobel Prize if it is proved true.

Researchers claim the treatment could be suitable for up to 40 percent of patients with severe pain for whom the only alternative is surgery.

However, the paper describing the research - which was based on just 162 patients - was turned down by leading medical journals such as The Lancet and BMJ. It was published on Tuesday in the European Spine Journal.

The proposed treatment is more complex than just replacing painkillers with antibiotics. It requires an MRI scan to detect distinctive “Modic” changes in the spinal column - named after the doctor who first observed them in the late 1980s - which are indicative of bacterial infection.

The examination can only be carried out by a practitioner trained to recognise the changes and distinguish pain caused by infection from that due to other causes. In appropriate cases the patient may then be prescribed a course of antibiotics for 100 days.

The long course of treatment - antibiotics normally clear infections in a week or two - is necessary because the infected discs in the spine have limited or no blood supply.

Peter Hamlyn, a private spinal surgeon at University College London Hospital, said the discovery was “the stuff of Nobel prizes”. He added: “This is going to require us to rewrite the textbooks.”

Hamlyn, who is the director of a spinal clinic in London and paid for Tuesday's launch, has set up a website with the treatment's discoverer, Hanne Albert, a physiotherapist from the University of Southern Denmark, to promote the therapy known as Modic antibiotic spinal treatment (Mast).

Dr Albert compared her breakthrough to the discovery 30 years ago of Helicobacter Pylori, a bacterium in the stomach that causes ulcers. Until the 1980s, stomach ulcers were thought to be caused by bad diet or stress and the only treatment was surgery. Today they can be treated with antibiotics.

She conducted a double blind, randomised study of 162 patients with Modic changes to their spines seen on MRI scans. One year after the end of treatment, those who received antibiotics had markedly less pain and disability and took less time off work than those treated with a placebo.

Despite the small numbers, the findings were “statistically significant and clinically relevant”, she said.

Dr Albert said she had had to battle against scepticism from scientific colleagues over her discovery, some of whom suggested she was contributing to the global problem of antibiotic resistance by promoting long-term use of the drugs.

She responded: “We want to inform patients and train GPs about this disease. We want to prevent indiscriminate use of antibiotics and unnecessary surgery.”

Asked why the major medical journals had declined to publish the paper, she said it “took guts” for a journal to go against the grain of established thinking. - The Independent

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