Friday, 10 May 2013

Antibiotics for back pain? Conflicts of interest?


The 'antibiotics for back pain' study has not been out of the headlines this week, certainly the PR campaign that has seen headlines made across the board in the likes of the Guardian and the Mail has been successful.  Really one has to look in depth at the paper and the literature to appreciate just how overly sensationalist and hysterical much of this media reaction has been.

Firstly 3 of the 4 authors are involved with a private company that appears designed to make money out of patients and clinicians in diagnosing and treating back pain with antibiotics.  Indeed these 3 authors are all MAST 'Academy' members.  The first major problem I have with their study is the fact that they declared to the journal that they had 'no competing interests'.  This appears dubious at best.  It is also dodgy that Peter Hamlyn, a surgeon from London who is also a member of this 'Academy', is quoted in the papers saying some very positive stuff without any hint that he may also have a rather glaring conflict of interest:

"More work needs to be done but make no mistake, this is a turning  point, a point where we will have to re-write the textbooks.....It is the stuff of Nobel prizes."

The 'MAST medical' concept appears rather dubious in itself.  Patients with Modic changes are encouraged to pay money to have their MRI scans interpreted, while clinicians are encouraged to become 'MAST certified' so that they can treat patients with Modic changes!  Why on earth an experienced clinician needs accreditation by 'MAST Medical' before treating a patient with antibiotics is beyond me, this just appears a cheap money making stunt.  It would be interesting to know just what the authors' exact financial interests are relating to MAST Medical.

There are also some rather significant problems with the study itself.  The bacteria attributed to be the cause of so many patients' back pain has been researched for many years, in fact since being reported as a cause of back pain in 2001 in the Lancet, Proprionobacterium Acnes (P Acnes) has been linked with other problems including shoulder arthritis.  The problem with this bug is that is is notoriously hard to grow in the laboratory, it is of unknown pathological significance and many groups have failed to replicate much of the P Acnes research.

The biggest flaw I have seen in the research is that about 50% of the patients treated with antibiotics had had previous spinal surgery, so it is highly possible that the benefits of antibiotics only apply to patients who have had previous surgery, so the way the study has been reported in the media is highly misleading.  P Acnes seems likely to be a bug that is only problematic after medical intervention like injections or surgery, there simply isn't any good evidence out there that it is likely to be a cause of back pain in the 'virgin' or 'intervention naive' back.

Overall this all just reminds me a bit of the MMR scare, but it is obviously the reverse of a scare.  The problem is that the way the study has been written, reported and spun out of context mean that many patients are going to be extremely let down when they realise what the reality of this study actually is.  A majority of the authors have significant conflicts of interests which they failed to declare, the benefits of antibiotics may only apply to patients who have had previous injections or surgery, and more research is badly needed to confirm this work with a more rigorously defined group of patients taking part.  Sadly the reality of the research wouldn't make any headlines and it certainly wouldn't have attracted as much attention for 'MAST Medical'.

52 comments:

David Colquhoun said...

Excellent post. Only one newspaper spotted Hamlyn, and none spotted the rest of the conflicts. It is sad that bloggers have to do the job that the journals should do (and which journalists should do).

ToruOkada said...

Ah. I wonder why they didn't declare their financial interests in the publication. Or rather - I don't.

I quite liked also the analysis in The Conversation:

http://theconversation.com/zit-bacteria-causing-back-pain-a-spotty-hypothesis-14060

They pointed out that the antibiotic used was amoxicillin plus clavulanic acid, the latter having antiinflammatory properties in itself. Another control that's missing.

Mark Hammonds said...
This comment has been removed by the author.
Mark Hammonds said...

Excellent work. Thank you. Mayhap you're not actually the esteemed author of the Slicer series?

Scott Griffin said...

I am a firm believer in using antibiotics. I have a great Salt Lake City chiropractor who really knows her stuff and she recommends using antibiotics to decrease inflammation in the back and help reduce the pain.

Catherine said...

you don't need antibiotics for back pain. all you need to do yoga and have a good massage.

Anonymous said...

Catherine said...

you don't need antibiotics for back pain. all you need to do yoga and have a good massage.
15 May 2013 13:36


You have a bad back and crippled with pain and see if Yoga will help you deal with the pain.. Let alone want to continue with Yoga... It would be great if this actually worked as pain is a horrible horrible experience. I hope it does not continue to effect me the rest of my life

Antibiotics said...

Antibiotics are medicine that kills bacteria or slows the growth of bacteria. They are used to cure diseases. Antibiotics do not harm people. Penicillin is a popular antibiotic.
Today, people worry that in future bacteria will not be affected by antibiotics, because bacteria might evolve and become too strong. This is called antibiotic resistance. This can happen when antibiotics are used too much. If they are used a lot, some bacteria may get used to them and not be harmed by them. This is when bacteria build up a resistance to the drug e.g. penicilin. These bacteria could then multiply and make a large colony which would not be affected by antibiotics. Therefore rendering the drug useless.

Antibiotics said...

Antibiotics are medicine that kills bacteria or slows the growth of bacteria. They are used to cure diseases. Antibiotics do not harm people. Penicillin is a popular antibiotic. Antibiotics cannot stop a virus. Antibiotics are not the same thing as antibodies.
Today, people worry that in future bacteria will not be affected by antibiotics, because bacteria might evolve and become too strong. This is called antibiotic resistance. This can happen when antibiotics are used too much.

Christer Nyberg said...

Very Good"
Keep up your good work. Interesting if you find out more. I should also write an (swedish) article about this soon in my Back Pain blog.
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Anonymous said...

I was suffering from lower right back pain for a long time , my cure was Antibiotics , I don't know why do they work or anything but my doctor gives me antibiotics once a month or so and i'm fine .

John Decker said...

This is a great article. I have had many lower back injury's from playing sports and they have never really healed. I have tried many antibiotics in the past but they were only a short term solution. I recently decided to get my back looked at again so I researched NYC Back Pain on the internet and I found a lot of options. Hopefully a doctor can recommend some long term solutions because I would really like to start running again. I knew something was wrong because I have been waking up in pain for a few weeks now so hopefully everything is alright.

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Anonymous said...

Can it work?

Anonymous said...

Financial interest and gets people out of pain! What's wrong with that. If there is a good chance of will succeeded then I have hope.

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Do massage chairs do any good with back pain. It is easy to get a vending massage chair.

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Scoliosis surgery said...

Maybe a pain killer pills but not antibiotics.

Andrew John said...

I agree with you and I have pinched nerve and think that the common medical treatment for a this is the use of non-steroidal anti-inflammatory drugs to decrease pain, but this treatment doesn’t take the pressure off the nerve, it only covers up the problem.

Thanks
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Chiropractic Care said...

I think that the antibiotics and other medicines can cure the back pain for a short while but the pain will keep coming back until you get a proper treatment for it.

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john thomas said...

The study is a new approach to address a common problem and its findings provide a good platform for further research. But the use of antibiotics now, without this further research, must be cautioned as it's not certain the treatment works and there is already an over reliance of common antibiotics.

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