Back pain breakthrough crippled by doubt
Claims that much chronic lower back pain was caused by a common bacterial infection and could be relieved with the use of antibiotics have become mired in controversy amid allegations of potential conflicts of interest.
As reported in Australian Medicine on May 20, the peer reviewed European Spine Journal earlier this year published a study claiming to show that up to 40 per cent of lower back pain was caused by a common bacterial infection that could be cured with antibiotics.
Based on a randomised double blind trial, the study concluded that treating patients with chronic lower back pain associated with vertebral bone edema for 100 days with a combination of amoxicillin with clavulanic acid reduced disability and pain, compared with 162 patients given a placebo.
But, since its release, the study has been surrounded by controversy.
Several researchers have questioned the methodology used in the study, and it has also been dogged by concerns about the failure of three authors to disclose the fact that they served on the board of a UK company that receives money to certify doctors in antibiotic therapy.
The publicly listed Modic Antibiotic Spine Therapy (MAST) Academy operates to educate the public and medical professionals on medic – bone edema (swelling) in the vertebrae that can only be detected by an MRI - back pain, and to certify clinicians in how to identify and treat the condition for a ₤200 ($314) fee.
Deakin University pain specialist Dr Michael Vagg told the Sydney Morning Herald that, while a link between bacterial infections and some back pain was plausible, the researchers had not demonstrated this type needs a Nobel Prize”.
Published: 17 Jun 2013