Up to half a million patients with chronic low back pain may be suffering from an infection that can be treated with antibiotics.
If proved true, the revolutionary theory about the cause of one of the commonest and most debilitating ailments should win its discoverer the Nobel Prize, one surgeon said today.
However, the paper describing the research based on just 162 patients was turned down by the leading medical journals such as the Lancet and BMJ. It was published today in the European Spine Journal.
Researchers claim the treatment could be suitable for up to 40 per cent of patients with severe, long term pain for whom the only alternative is surgery.
However, it is not as simple as replacing the painkillers with antibiotics. The treatment 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 a limited or no blood supply.
Peter Hamlyn, a private spinal surgeon and honorary consultant neurosurgeon 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.”
Mr Hamlyn, who is director of The Spine Surgery near Harley Street, London, and who paid for today’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 MAST – Modic Antibiotic Spinal Treatment.
Dr Albert compared her breakthrough to the discovery 30 years ago of Helicobacter Pylori, a bacterium in the stomach that causes stomach ulcers. Until the 1980s stomach ulcers were thought to be due to bad diet or stress and the only treatment was surgery. Today they can be treated with antibiotics.
She conducted a small 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 placebo.
Despite the small numbers, the findings were “statistically significant and clinically relevant”, she said. The most important change for the patients was that they were in pain for a much shorter time each day.
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.
But researchers had ridiculed the discoverers of Helicobacter Pylori and its link with stomach ulcers for a decade, she said.
“We are not advising patients to go and get a prescription from their GP. 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. “After it had been rejected by three journals I wrote to the editor of the European Spine Journal and asked if he had the guts to do it.”
Mr Hamlyn said general journals, however great their reputations, tended not to have peer reviewers who were specialists in the spine, unlike the specialist journals. “There are a number of professional rivalries – dark forces,” he added.
Alan Gardner, former consultant orthopaedic surgeon, trustee of the Back Care Association and a member of its research committee, said the discovery was “a very interesting development.”
“It sounds like a very attractive theory. We will certainly be looking at this at the Back Care Association. However, an MRI scan costs £300 to £500 on the NHS – it is not something you would do lightly.”
Dr Donal McNally, Associate Professor of Bioengineering, University of Nottingham, and a member of the editorial board of the European Spine Journal said: “This is an extremely important piece of research. As the authors note, it is a specific treatment for a specific form of low back pain (following disc herniation). Of the 16,500 people who attended outpatient clinics with low back pain in England in 2011-12, it may have helped 1,200 (40 per cent) of the 3,000 with disc herniation.”
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