‘Nobel-worthy’ MEDICAL BREAKTHROUGH: Antibiotics could cure 40% of back pain patients

Originally posted by LastStarfighter
First, this is bull. 40 percent of back problems aren't related to an infection. If you have an infection in your spine your CNS is infected and you get meningitis or worse. The only way to determine it would be to spinal tap everyone with back pain and this DOES NOT happen.

Second, why not post which peer reviewed journal this is from and the data?

Third, trying to get everyone with back pain to take antibiotics is not only non effective but also dangerous because you're going to increase bacterial resistance in the population and resistant bacteria will emerge.

The headline is good and sensational though since many ATS people might have back pain.

edit on 8-5-2013 by LastStarfighter because: (no reason given)

It says "lower back pain" not "spine pain". As an RN I know that many infections can cause diffuse pain in the lower back, so I totally buy this research.

I'd like a link to the article... OP do you have one?

reply to post by LastStarfighter

Originally posted by LastStarfighter
First, this is bull. 40 percent of back problems aren't related to an infection.

...

Second, why not post which peer reviewed journal this is from and the data?

I would have assumed you could read well enough, or at least do your own relatively easy research for the answer.

In the first of two papers published in the European Spine Journal, Danish researchers showed how bacteria invading the injury sites of slipped discs caused painful inflammation and damage to surrounding vertebrae.

Infection was previously thought to play only a small role in back pain. But nearly half the slipped disc patients studied by the scientists tested positive for bacterial infection.

The vast majority of infections were caused by Propionbacterium acnes, the bug responsible for acne.

P. acnes secretes an acid capable of dissolving bone, leading to painful bone swelling. The bugs may be to blame for up to 40% of all cases of chronic lower back pain, the researchers believe.

The second study tested a new form of treatment based on the discovery.

A group of 162 patients who had suffered from chronic back pain for more than six months following a slipped disc, and had signs of bone swelling, were either given a 100 day course of antibiotics or an inactive placebo drug.

The antibiotic treatment proved effective in 80% of cases, leading to significant reductions in pain and disability.

In their paper the scientists, led by Dr Hanne Albert, from the University of Southern Denmark, wrote: “Antibiotics should be considered as a treatment option for this special subgroup of patients with CLBD (chronic low back pain)..

Link.

But I guess we should blindly accept your unsupported pronouncement this is all bull.

reply to post by InternalMedDoc

Originally posted by InternalMedDoc
There are only two types of medicine: proven and unproven.

While I agree with most of what you have said in this thread, the above statement is somewhat misleading.

Not much is really "proven" anywhere in medicine, despite pronouncements to the contrary. History certainly teaches that.

I prefer softer language when it comes to therapies of any type. Some are more or less beneficial-- causation more or less likely. Proven/unproven don't seem like really workable standards to me.

Just sayin'

Originally posted by loam

Not much is really "proven" anywhere in medicine

Sure it is. We have proven that NSAIDs decrease inflamation. We have proven that being on statins decreases mortality from pneumonia. We have proven that beta blockers lower heart rate.

Just because you've proven a medication has a certain effect doesn't make it immune from later proof that its harmful or isn't AS effective as other meds.

reply to post by InternalMedDoc

I actually knew people who flew jets in the airforce and also a commercial pilot. I also logged in about nine hours of flight time in a couple different planes when I took flight classes. I can fly an airplane.

The doctor I was talking about was mostly telling people to take certain mineral supplements or specialized vitamins to treat certain symptoms. Being that a lot of diseases have their roots in deficiencies he was getting good results but his customers did not return when their problems disappeared. So he was "layed off" when a reduction was needed and because of a contract he can't practice in the area for a while. His patients learned to treat their own problems and the hospital lost revenue.

Did you have the "Economics of being a doctor" speech when you started Pre-med? I just talked to a newly graduated physician a year ago and he said they still had it. I would have had all my med school paid by a connection of mine from Gary Indiana. He was on the board of the AMA and said if I wanted to go school down there he could get it paid for. I would have had to stay in a cottage on his estate and helped do a little yardwork in the summer between the fishing and hunting trips. I met the guy at a fish fry in Alaska. He came up with his two friends and we went out bird hunting a few times. Real nice guy, owned an oil company and his friends were into propane. That is back when private people owned big businesses.

I'm no stranger to medicine, been back to studying it on my own for six years now, tracking down how Pharmacuticals work and finding alternative sources in nature. The hardest thing is trying to properly identify a deficiency in a mineral or vitamin or chemical in a person. So many deficiencies and overdoses of these things have the same symptoms.

Depressed, eat a hot dog with mustard and onions and one beer. Beats taking antidepressants and actually in most cases it can do the same exact thing in the body. Three times a week

reply to post by InternalMedDoc

Originally posted by InternalMedDoc
Sure it is. We have proven that NSAIDs decrease inflamation. We have proven that being on statins decreases mortality from pneumonia. We have proven that beta blockers lower heart rate.

Just because you've proven a medication has a certain effect doesn't make it immune from later proof that its harmful or isn't AS effective as other meds.

Perhaps we are disagreeing on semantics.

From my perspective, when there is substantial evidence that something is likely, it is still not proven. There is a material difference between making a despositive determination about something and a probable one. Moreover, I'm surprised a physician would be so willing to speak in terms of absolutes. (Perhaps, I shouldn't be. But we can save that discussion for another thread.)

Medicine is filled with imperfect or erroneous understandings about disease and body function. My point was merely to suggest there is danger in pronouncing certain things as fact. Moreover, these "facts" are often riddled with assumptions of benefit that later prove untrue.

Even with respect to the three examples you provide, the way your position them leaves room for dispute.

For example, NSAIDs do not decrease all types of inflammation, such as in the case of Alzheimer's, which also involves inflammation. Until recently, NSAIDs were also believed to be beneficial to those with cardio vascular disease on the same 'reduces inflammation' theory, but in fact turns out to increase the risk of heart attack- particularly for those patients with previous history of heart attack or pre-existing cardio vascular disease.

While I haven't spent a whole lot of time researching the topic, even the assertion that statins are "proven" to decrease pneumonia mortality is questioned by the quick search I did on this topic:

Although statin use is associated with decreased mortality after pneumonia, this effect weakens in important subgroups. Only a randomized controlled study can fully explore the link between statins and pneumonia mortality.

2012 NIH Link

See also: Are statins beneficial for viral pneumonia?

it is clear that additional research into the underlying mechanisms, and potential beneficial effects, of statins for both viral and bacterial infections is needed. Although animal and human research to date is promising it is still unclear if these medications are truly beneficial and whether acute initiation of statins will ever be recommended at the time of diagnosis for those with viral and/or bacterial infections.

Seems hardly "proven" to me, even if it appears probable.

I guess I've made my point.

To be clear, I'm not an anti-science guy. Far from it. I merely bristle at most proclamations of "fact" and the implications and conclusions they tend to spawn.

The back study in the OP is a great example. Ulcer theory is another great example. The causative "facts" in both of those examples changed.

Sometimes, we just get these things plain wrong.

I work in a large hospital and suffer from lower back pain.
I will bring this up with the Orthopod during my next appt and see if he has any idea of this study whatsoever.

The theory is sound. Small pustules/infections growing in microfractures of the bone. This is indeed an important find if it proves true. I would love to not have to have surgery.

I don't see this being hushed away due to some "conspiracy" on the medical front. Remember, antibiotics are made by the drug industry. Surgeries are performed by specialists/physicians who usually have nothing but the interest of their patient population in mind.

Originally posted by rickymouse
I actually knew people who flew jets in the airforce and also a commercial pilot. I also logged in about nine hours of flight time in a couple different planes when I took flight classes. I can fly an airplane.

You get the point I was trying to make.

[quote[ So he was "layed off" when a reduction was needed and because of a contract he can't practice in the area for a while. His patients learned to treat their own problems and the hospital lost revenue.

So he was laid off due to a reduction in work force. That doesn't at all sound like he was fired for using different treatments.

Did you have the "Economics of being a doctor" speech when you started Pre-med? I just talked to a newly graduated physician a year ago and he said they still had it.

Nope. We had a few optional economics lectures my last year of medical school, but they were mostly focused on what options were available to us for student loan repayment (public service versus private contracts that forgive loans versus just paying it off)

[ He was on the board of the AMA and said if I wanted to go school down there he could get it paid for. I would have had to stay in a cottage on his estate and helped do a little yardwork in the summer between the fishing and hunting trips. I met the guy at a fish fry in Alaska.

He came up with his two friends and we went out bird hunting a few times. Real nice guy, owned an oil company and his friends were into propane.

That sounds like it would have been a fantastic deal!

Depressed, eat a hot dog with mustard and onions and one beer.

Beats taking antidepressants and actually in most cases it can do the same exact thing in the body. Three times a week

As great as hotdogs (with tons of relish) and beer are, it's unlikely it was true depression if that's all it took to cure it. Of course, if you can get a study done to support it, I'll wheel a hotdog and beer cart into the clinic myself every day, haha

Originally posted by loam
From my perspective, when there is substantial evidence that something is likely, it is still not proven. There is a material difference between making a despositive determination about something and a probable one. Moreover, I'm surprised a physician would be so willing to speak in terms of absolutes. (Perhaps, I shouldn't be. But we can save that discussion for another thread.)

As I said, proving something has an effect doesn't make it immune from other studies.

For example, aspirin has fantastic anti-inflammatory and anti-coagulant properties. We know this for a fact, is is proven. After the drug came into common use as an everyday anticoagulant, studies found that it can also contribute to stomach ulcers.

So, does proving aspirin has a negative effect take anything away from the proven positive effect? Absolutely not, it's simply two proven facts about a single entity.

That being said, there are statistical values (namely, power, significance, number-needed-to-treat and number-needed-to-harm) that allow us to look a a given study about a drug and decide if the study represents proof or suggestion that drug X has effect Y. Just because a study comes out of some powerhouse university about a drug having some new effect doesn't mean it's proven. All of us, as physicians (as well as the governing boards of each field) will look at that study, and any performed in the past, and evaluate it on those statistical ground to determine just how strong of a study it is.

There's a LOT more to proving a drug's effect than you're giving credit for. We don't just run quick, 10-15 patient clinical trials and then start using a drug for a new treatment.

Medicine is filled with imperfect or erroneous understandings about disease and body function.

Imperfect, certainly. Erroneous, I don't think that's true. There are plenty of disease processes and pathologies that are still poorly understood, but we don't put bad science in as a placeholder for that knowledge. I am more than willing to admit that I just don't know how the beta protein in Alzheimer's originates. Is it partially genetic or totally genetic? Is there an environmental factor or not? We just don't know, and I would never tell a patient (nor would the vast majority of physicians) that Alzheimer's is **definitely** caused through X or Y route.

. Moreover, these "facts" are often riddled with assumptions of benefit that later prove untrue.

I think you need to qualify your use of "often" with examples. If it happens as often as you say, you should be able to find plenty of example in the last 5 years of medical literature.

For example, NSAIDs do not decrease all types of inflammation, such as in the case of Alzheimer's, which also involves inflammation. Until recently, NSAIDs were also believed to be beneficial to those with cardio vascular disease on the same 'reduces inflammation' theory, but in fact turns out to increase the risk of heart attack- particularly for those patients with previous history of heart attack or pre-existing cardio vascular disease.

You're cherry picking. Taking two VERY specific subgroups (cardio patients, but only those with prior heart attack) and then claiming that NSAIDs are NEVER good for cardio health is being disingenuous. The use of NSAIDs as a daily anti-coagulant/anti-inflammatory is HIGHLY associated with decreased risk of cardiac event.

Although statin use is associated with decreased mortality after pneumonia, this effect weakens in important subgroups. Only a randomized controlled study can fully explore the link between statins and pneumonia mortality.

Again, you've picked ONE subgroup out of the larger patient population. Not every therapy will work for ALL patients, but in the general patient population, statins ARE associated with decreased mortality from pneumonia. If you honestly expect me to put a blackbox warning about the tiny segments of populations who shouldn't use a given therapy in a conspiracy theory board post, you're nuts.

reply to post by InternalMedDoc


Like I said, our conversation is essentially an argument of semantics. I doubt we substantively disagree on most of the science.

Originally posted by InternalMedDoc
...If you honestly expect me to put a blackbox warning about the tiny segments of populations who shouldn't use a given therapy in a conspiracy theory board post, you're nuts.

No black-box warnings required.

I merely began our exchange by expressing the point of view that using the word "proven" implies a level of certitude that should not be used lightly. It's a word that is easily abused and in many instances serves to foreclose upon additional thought regarding the subject matter where it is deployed. (Frankly, when I hear the word "proven" used in almost any context, it's usually my first indication that something is very likely not proven. )

I think using simple, qualifying language (particularly on most medical subjects) isn't all that burdensome-- conspiracy board or not. Moreover, saying something is highly probable or likely in favor of saying something is "proven" doesn't materially diminish the value of what is being described.

What's you problem with that?

Originally posted by InternalMedDoc
There's a LOT more to proving a drug's effect than you're giving credit for. We don't just run quick, 10-15 patient clinical trials and then start using a drug for a new treatment.

Please don't insult me by assuming I think otherwise. I'm well aware of how scientific and medical studies are conducted. And while I don't think conspiracies necessarily lurk around every corner,
I'm also aware how fraud and error taint conclusions and frequently remain undisclosed- particularly where pharmaceuticals are concerned.

I simply advocate reasonable caution against statements of certitude. It fascinates me that as a physician you're essentially arguing I should just accept pronouncements that something is "proven" and move along.

Nice....and very disappointing when coming from a physician.

Originally posted by InternalMedDoc
You're cherry picking. Taking two VERY specific subgroups (cardio patients, but only those with prior heart attack) and then claiming that NSAIDs are NEVER good for cardio health is being disingenuous. The use of NSAIDs as a daily anti-coagulant/anti-inflammatory is HIGHLY associated with decreased risk of cardiac event.

First, show me where I said "NEVER" again?

My precise words on that example were:

"Until recently, NSAIDs were also believed to be beneficial to those with cardio vascular disease on the same 'reduces inflammation' theory, but in fact turns out to increase the risk of heart attack- particularly for those patients with previous history of heart attack or pre-existing cardio vascular disease."

Who's being disingenuous?

For a man (or woman) of science, you seem terribly imprecise.

reply to post by InternalMedDoc


A real hot dog contains bound glutamates. The mustard contains turmeric which is a MAO inhibitor. Many antidepressants contain chemistry that either adds glutamates or adjusts it. If the body can't take apart tyrosine than there is a problem that can also be corrected. If the body has too much copper, boosting the glutamates also helps and beer also contains ample supplies of molybdenum from the hopps seeds so it lowers copper levels. Too high copper levels can cause depression. The molybdenum present in beer makes it harder to get an acetylaldehyde or sulfite headache from it. Unless you drink a lot. The sulfur compound in the onion helps to regulate clotting, sure the beer will do that but just one won't work well. Plus the alcohol in beer lowers water released from the cells is peed out. Beer contains a lot of B vitamins, and contains salt. cyanocobolamun also makes you pee. The onion is a diuretic so the extra water is expelled. Tyramines raise blood pressure way more than salt. Turmeric also has diuretic properties.

Beer is also treated with Bromelaine or sometimes Papain to clarify it, residues of these natural chemicals are often present in it. They help to break up mucus and they can also break down the coating around tumors to allow the body to attack the tumor. A little Bromelaine also makes it possible for some people to drink milk, breaking apart the protein that gets through the gut. It also helps some to break down lactic acids in the blood. I'd rather eat a fresh pineapple though than drink beer or booze everyday.

I read that they use bromelaine to treat some conditions in the emergency rooms to break up mucus buildup in the lungs, Have you any knowledge if that is true?

I also read that they sometimes give Sodium acetate, (a product made from combining vinegar and baking soda), intravenously for dehydration sometimes. How do you know whether to give Sodium acetate or Sodium Chloride? Can't find that particular info on the net anywhere.

I'm still learning but am trying to fit everything together to figure out why, not just treat symptoms. I'm looking at correcting metabolism problems so people don't need to take pills to feel good.

Easing back pain by obliterating your digestive system... seems about right
2nd

You being a nurse, you should know back pain 99 percent of time isn't cause by infection. Glad you can't write scripts!

Its good to see some one with science knowledge talk.

reply to post by bacci0909


When they give a chicken antibiotics it grows faster. When they give cattle antibiotics they grow faster. Sometimes treating plants with chemicals similar to antibiotics makes them grow faster.

I think it is because the animal or plant spends less energy fighting bacteria and fungus that aren't there anymore so can spend more energy repairing and growing. Although antibiotics don't fight viruses, their use takes away some other things that the body is fighting and gives it more energy to fight viruses. The only problem with using antibiotics to treat a virus is that sometimes the microbes we have in our body can help us to fight viruses, they are symbiotic. I guess it should be the call of the doctor prescribing the antibiotics. When a doctor has been practicing for many years he just senses what to do in certain cases....if they aren't restricted by stupid policies. They can always diagnose a person with one thing and treat another properly I suppose. Why do we let the experienced doctors retire without training in the new ones

The training of the new docs different. In the mid nineties it became highly pharma based with pharma even taking medical students out to lunch. This continued up until the housing bubble in roughly 2006.

Secondly medicine changed due to liability. As a doc in training in residency in a private hospital you are told many times to run a decision through "risk management" before making a choice. Risk management is just the hospital lawyer.

Really the fear of being sued is what has ruined medicine because it prompts the doc to get all tests even if unnecessary to cover their rear, and also they "think" they are helping the patient since "the insurance will pay it"

And this bring us to the current condition. Bottom line is don't go unless you have a real illness like a broken leg, otherwise you are likely to get worse.

reply to post by InternalMedDoc


I guess you can get side effects form any prescription.....sports.yahoo.com...

T

I find all of this rather hard to swallow.

Mechanical defects ,cannot be corrected with antibiotics .
They just cannot ,regardless of any underlying infection .
40% is a very high number.
Best guess,this was slipped into the media ,so everyone with a back twinge will run out and bug their MD for an antibiotic script .
Serious fail