Last week I mentioned that there was an idea that chronic back pain could be a symptom of an infection which has shown to be successfully treated with antibiotics.

While not advocating taking antibiotics ad hoc, researchers at the Spine Centre in Denmark carried out an interesting study. They put 162 back pain sufferers on a 100-day course of amoxicillin antibiotics.

The participants had suffered from chronic back pain for at least six months following an operation for a herniated disc. Half of the group were given the antibiotic, while the other half were given a sugar pill or placebo.

After a year, those taking the antibiotic reported significant improvements in pain and mobility. MRI scans showed that the antibiotics had shrunk the swelling of the bones, a sign of infection around the disc (European Spine Journal, 2013).

The infection around the herniated disc was due to propionibacterium acnes bacteria (which causes acne). This bacteria is usually found in the follicles, but it can enter the bloodstream and end up in the spinal disc. One of the researchers, rheumatologist Claus Manniche, said: “Our studies show that at least 40 per cent of the herniated patients lying on the operating table are infected with P.acnes bacteria. It is possible that early intervention with antibiotics may prevent the infection from becoming chronic pain.”

In an earlier study, five years previously, Manniche and his team had also successfully treated 29 back pain sufferers with amoxicillin. In addition, it is a therapy being used as part of day-to-day care at the Institute of Sports Exercise and Health at University College Hospital in London, by Peter Hamlyn, a consultant neurosurgeon.

Hamlyn has treated a number of sufferers with antibiotics instead of surgery. He has even set up a web-based training company, The MAST Medical Academy, to help specialists understand the new antibiotic therapy and how and when to apply it.

The worry is, and Hamlyn enforces this view, that consultants will start using antibiotics for every type of back problem. This is more especially likely, as so many current treatments for back pain are ineffective.

The antibiotic treatment should be reserved for those who have had disc-herniation surgery, which represents around 20 per cent of all back pain cases.

It must be mentioned, and has been reinforced by the Danish study, and by Hamlyn, that the antibiotics bring their own side effects. Some of the participants in the earlier Danish study had diarrhoea and other gastrointestinal problems which were serious enough to make them drop out of the study. In addition, this could add to the overuse of antibiotics, which is hastening the emergence of the antibiotic-resistant superbug. So all these facts should be taken into consideration when deciding whether to take up antibiotic therapy to treat back pain.

Last week I mentioned that one of the causes of back pain was stress. If this is the case, try the mind-body exercise of yoga. There is plenty of evidence to suggest that it could work. When tested against exercise and advice from a self-care book, 101 back pain sufferers who took part in weekly yoga sessions for 12 weeks had greater mobility and flexibility than those in the other two groups.

However, the exercise group started to report better levels of mobility after 26 weeks. Yoga was also tested against stretching and showed a more profound effect by the end of a 12-week programme.

For many chronic back pain sufferers, the only respite is a painkiller

For many chronic back pain sufferers, the only respite is a painkiller. However, studies have shown that a course of acupuncture could help. A group of 1,162 back pain sufferers were tested for an average of eight years.

They received either 10 sessions of acupuncture twice a week, sham acupuncture where the needles were not correctly inserted, or conventional therapy with painkillers, physical therapy and exercise (Euro. Spine J., 2013).

After six months, 48 per cent of those in the acupuncture group reported dramatic reductions in pain compared with only 27 per cent of those receiving conventional care. Interestingly, 44 per cent of those given the sham acupuncture also reported pain reduction, suggesting the importance of the mind-body connection when it comes to back pain.

Finally, there are some important supplements to consider to help back pain. They are B complex and C vitamins. The spine is surrounded by cerebrospinal fluid which, in healthy individuals, contains a higher concentration of these water soluble vitamins than is commonly found in blood.

A combination of thiamine (B1), vitamin B6 and vitamin B12 has been shown to significantly improve symptoms in those complaining of back pain.

In one study, sufferers took a combination of 100mg of B1, 200mg of B6 and 0.2mg of B12, three times a day over six months. Only 32 per cent of those taking the vitamins suffered a relapse compared to 60 per cent of those taking a placebo.

Vitamin C is necessary to maintain the integrity of the intervertebral discs. Being deficient in copper and selenium may also be contributory to chronic back pain; 90-100mcg of selenium alone, or in addition to 20 IU of vitamin E, taken daily, has shown to improve musculoskeletal complaints.

kathryn@maltanet.net

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