My Aching Back: Antibiotics can relieve back pain caused by bacterial infections
September 9, 2013 8:00 AM
UPMC neurosurgeon Joe Maroon talks to a patient in his office in Oakland.
By Jack Kelly Pittsburgh Post-Gazette
Part 2 of a series of stories on back issues:
A discovery by researchers at the University of Southern Denmark, confirmed by a trial in Britain, offers the prospect of relief for millions who suffer from chronic low back pain.
In two papers published in the European Spine Journal in April, the Danish scientists reported they'd found that at least 20 percent, and perhaps as much as 40 percent, of all chronic low back pain is caused by bacterial infections.
One of Britain's most eminent spine surgeons said the discovery is the most important he's witnessed in his professional life, because bacterial infections can be cured by antibiotics, he told the Guardian newspaper.
"This is vast," Peter Hamlyn said. "We are talking about probably half of all spinal surgery for back pain being replaced by antibiotics."
In the first paper, the Danish scientists explained how bacterial infections inside slipped disks can cause painful inflammation, and tiny fractures in surrounding vertebrae.
The vertebrae (bones) of the spine are cushioned by small, spongy disks which, when healthy, act as shock absorbers. But when damaged, a disk may bulge or break open. This is called a herniated, or slipped disk. When a herniated disk presses against nerve roots, it causes pain.
The bacteria Propionibacterium acnes is better known for causing acne, but normally causes no other harm. But when a person suffers a slipped disk, the body grows small blood vessels into the disk. The body does this to facilitate healing, but the small blood vessels can ferry bacteria into the herniated disk, the Danish scientists found.
In the second paper, the Danes, working with doctors in Birmingham, England, showed that taking antibiotics for 100 days reduced significantly the pain of 80 percent of those who received it during a randomized clinical trial.
When the trial began, 73.5 percent of the patients reported being in constant pain. After the course of antibiotics was completed, only 19.5 percent did.
For pain reduction, this is a better result than what customarily is achieved by back surgery. In a 1998 study, only 29 percent of workmen's compensation patients reported a reduction in pain after spine surgery.
Health care costs could be cut by billions of dollars, because the antibiotics cost much less than most back surgeries do.
Joseph Maroon, vice chairman of the department of neurological surgery at UPMC, performs 200 to 250 disk surgeries a year. More research needs to be done, especially on the side effects of taking antibiotics for 100 days, "which is a long period of time," he said. But the Danish discovery could be "seminal" -- comparable to the discovery of penicillin, he said, adding that he plans to test for the presence of the bacteria before going ahead with surgery.
"I'm culturing all my patients now."
Next week: Surgery isn't the first treatment recommended unless it's a case of cauda equina, and prevention of back pain lies in good lifestyle habits.