by Alan Jordan
There has been a flurry of media activity regarding Dr Hanne Albert’s recently published and ground breaking research in the treatment of a subgroup of chronic low back pain patients with antibiotics. All of these patients had demonstrable Modic changes on their MRI scans. In my opinion, Dr Albert’s study – the result of many years of work and the most recent of a very large number of published papers – while taking us a quantum leap forward did not suggest that she and her group have discovered a “miracle cure”.
In the study, the authors used validated and commonly used “outcome” measures to access the clinical improvement of the treated group versus those that received placebo treatment. These outcome measures included questionnaires relating to the ability of patients to manage common daily activities such as household tasks, going for walks and so forth – all measured on the Roland Morris Disability Questionnaire. Pain scales measured on numerical box scales that accurately reflect the patient’s perception of how much pain they were experiencing, numbers of hours of pain during the day in the last month, days off work and so forth. All of these outcome measures are well known and commonly used in spinal research projects.
Is Antibiotic Treatment a Miracle Cure?
Let me start off by stating that conventional treatments for chronic lower back patients do not demonstrate impressive results and no one really disputes this. Compared to conventional treatments the results obtained in Dr Hanne Albert’s study are far greater than those seen to date. The majority of patients (60-70%) experienced a clinically significant improvement in their status – most importantly, this was across the entire array of outcome measures used in the clinical trial. Differences were naturally statistically significant as well. So then, is this a miracle cure? No, but I would not want to take this debate up with a patient who could hardly get out of bed and who now has no trouble with daily chores and has returned to work as well. They might well feel that they have experienced a “miracle” after having tried so many other types of treatment with no effect. The patients enrolled in this clinical trial were experiencing severe symptoms, much but not all of their symptoms were due to the infection that was targeted by the antibiotics. One would naturally expect – as is the case – that these patients who still have degenerative changes in their spinal discs and joints are going to experience some degree of difficulty, but their new status is manageable. For most, this was a huge step forward.
The results of Dr Albert’s research will unquestionably lead to additional studies that will add valuable information regarding the ideal dose and duration of antibiotic treatment and perhaps methods by which we can identify those patients that are most likely to benefit from this treatment. These studies will likely be undertaken in many research institutions across the globe due to the enormous burden, costs and patient suffering related to chronic lower back pain.
Dr Alan Jordan Chiropractor Phd
Broadgate Spine & Joint Clinic