Throughout medical history, it was always believed that peptic ulcers were simply the result of gastric acid and inadequate mucus lining within the digestive tract, the primary causes being diet and stress. Sufferers lived for years with ulcers, with acid blockers, antacids and dietary changes helping to control the severity and symptoms of the ulcer. More often than not, however, these measures did not result in the ulcer disappearing.
That all began to change in the late 1990′s. Evidence for bacterial infections being involved in peptic ulcer disease had existed for many years, but conflicting experimental results lead early researchers to conclude that the bacteria detected in the stomachs of ulcer patients was caused by laboratory contamination. Indeed, the treatment of ulcers with antibiotics had been established as early as the 1950′s, but failed to gain widespread acceptance. It was not until the late 1990′s that a number of clinical studies conclusively proved that the overwhelming majority of peptic ulcers are caused by the bacteria Helicobacter pylori and that its treatment with antibiotics can cure upwards of 80-90% of ulcers. Doctors Robin Warren and Barry Marshall, both of Australia had spearheaded the research that ultimately discovered the role of bacterial infections in ulcers. They shared the Nobel Prize for this discovery in 2005.
The discovery forever changed how we view and treat peptic ulcers. It did not entirely invalidate the role of stress in the formation of ulcers, since it likely plays a roll in producing the conditions where a bacterial infection can take root, but it resulted in new tests and protocols and the use of antibiotics in treating and curing peptic ulcers. Countless lives have thus been improved.
We may now be on the cusp of a breakthrough that will dwarf the discovery of bacterial infections as the root cause of most ulcers
Back pain breakthrough could eliminate need for major operations
The figures make for grim reading. When all costs are considered, the NHS spends more than £1bn each year on back pain. More than half goes on hospital costs. But £140m covers GP consultations, with even more spent on physiotherapy sessions. On any given day, 1% of the national workforce is on leave with a back problem.
Most people recover from acute back pain within six weeks but for a fair portion, around 8%, the problem becomes long-term. In the past, doctors prescribed bed rest for back pain. They now accept that only makes the pain worse, and instead recommend physical exercise, or at least staying active.
In more than 80% of cases, there is no clear cause of back pain. But to the long list of factors, from lifting and posture, to stress and anxiety, scientists in Denmark have now added bacteria.
Microbes should not be lurking in the spine, but Hanne Albert and her team at the University of Southern Denmark found a common bug called Propionibacterium acnes inside the slipped discs of patients who had operations for the problem. The bacteria normally live without oxygen, in hair follicles, or at the bottom of crevices in teeth, but brushing teeth can sweep them into the bloodstream.
The bacteria should pose no threat as they circulate around the body, but when a person has a slipped disc, the body grows fresh blood vessels that reach into the soft disc to repair the tissue. This gives the bacteria a route in, where they can thrive, scientists believe. As the bacteria grow, they cause inflammation around the disc, and release propionic acid, which irritates nerves, and may even cause the painful microfractures seen in vertebrae around the disc.
The Danish researchers found that a long course of common antibiotics, lasting three months, killed off the bacteria, and alleviated pain in most patients who took part in their trial. All had been in pain for more than six months and showed signs of vertebrae damage in MRI scans. They took six to eight weeks to feel better.
The drugs must be taken for so long because the blood supply to spinal discs is very poor. Once the disc is free from infection, the inflammation dies down, and the vertebrae begin to heal.
The discovery could transform the treatment of chronic lower back pain and save health services millions of pounds by doing away with unnecessary operations. When patients have no other options, surgeons can fuse damaged vertebrae, or transplant artificial discs into their spines, but both of these operations might largely be replaced with courses of antibiotics.
You probably know someone with chronic back pain. Perhaps you have it. It’s very common. Millions around the world suffer from chronic back pain and it can have an enormous effect on quality of life. For many, it’s not the severity of the pain as much as the fact that it never goes away. For others, back pain flares frequently to the point of extreme intensity. Many live for their entire life without ever getting lasting relief from back pain.
While this discovery does not apply to all back pain sufferers, it is still a very large portion. If infections are to blame, then this is not simply a treatment to relieve the symptoms, but rather a cure that can offer the potential for lasting relief of the chronic pain that has plagued some for decades.
The benefits go beyond just easing suffering, however. Back pain results in billions of dollars being spent by individuals, health insurance companies and national health benefits. Surgeries are common and include such things as spinal fusion. Many go through long physical therapy or use products like orthopedic shoe inserts, back braces or supports for relief. Regular Botox injections have been used to treat lower back pain. Other therapies include transcutaneous electrical nerve stimulation, pain killers, anti-inflammatory drugs and muscle relaxants.
Even beyond the direct cost of treating so many, massive savings could potentially be had from everything from disability payments to workers compensation to overall reduced productivity. The prevalence of back pain really makes the potential for revolutionary changes mind-boggling.
There is another point here that should not be lost. There are many out there who will claim that the big pharmaceutical companies are so powerful that any research which could hurt their bottom line simply won’t happen or the discoveries will be suppressed. Yet, that is exactly what this study is. Granted, curing 40% of back pain sufferers is not likely to drive any drug companies bankrupt, but it will not help them when it comes to profits. Back pain sufferers are exactly the kind of customers drug companies love. For decades on end, they are reliable customers, taking huge doses of pain killers, anti-inflammatory drugs, muscle relaxants and drugs to aid in their sleep. Chronic pain often leads to the need for antidepressants. Surgeries and hospital stays result in the need for numerous drugs and medical supplies.
Antibiotics, on the other hand, are cheap, and drug companies only make modest profits off the sale of most antibiotics. The treatment of a back infection, even if it requires one hundred days of therapy is still a one-shot event. It’s not the kind of reliable decades-long drug consumer that pharmaceutical companies make so much of their money off of.
Note that, as with any such study, one must be cautious and not assume this is yet proven. That said, the data looks very very good and compelling. I would say there is every reason to be optimistic. Perhaps cautiously optimistic, but still optimistic on this one.
You can read the actual study here. Sorry, it’s not free, unless you have access to an academic journal service.
(Someone was kind enough to send me a copy but asked that I not post any part of it)
This entry was posted on Wednesday, May 8th, 2013 at 7:47 pm and is filed under Good Science, Misc. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
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