Bacterial cause of chronic back pain?

hi all,

thought you may be interested in research which has recently revealed that up to 20-40% of people suffering chronic back pain may be suffering from a recently identified bacteria which can infect spinal soft tissue. But, as with most findings, it is rarely as simple as that. For a discussion of this (as well as a link to the news report), and its implications for the TMS approach, go to:-

http://drjamespsychologist-com.webs.com/apps/blog/

or

http://www.facebook.com/pages/Dr-James-Alexander/323849141056608?fref=ts

an interesting topic and worthy of discussion on any of the available forums.

 

The first link was not working but I read the FB post. I'd read about the study this week and wondered how it impacted on TMS. Thanks for the explanation.

 

However, if it's just a bacterial infection in the soft tissue of the spine that's responsible for chronic back pain, why do the rates of chronic pain vary so much between the developed and undeveloped worlds? If, as you point out in your book, Dr Alexander, 1 in 3 people in the US suffer from chronic pain, 1 in 4 in Europe and 1 in 5 in Australia, why does the bacteria strike more people in the US? Must be some other factors at work; I would think having to do with greater psychological stress making certain populations more susceptible to the bacteria.

When I used to go to orthodox physical therapy back in 2001-2002 for a so-called herniated disk, now that I look back, I certainly notice that everyone with back, shoulder, knee or foot pain in there had undergone a recent traumatic life-changing event: loss of mother/father, divorce, loss of income, a parent with dementia moving in the house . . . . always something nasty like that that preceded the onset of symptoms. Makes me suspect that emotional factors played a huge role in producing TMS symptoms. But did those emotional upsets lower their autoimmunity, which, in turn, let the bacteria invade their soft tissue? And is that bacteria always present, ready to start acting up after a period of emotional stress?

The case of ulcers, which often occur in conjunction with a bacterial infection, immediately came to mind. Does this mean that the rates of chronic back pain will go down with antibiotic treatment only to manifest as other preferred PPD symptoms, like pain in the knee, shoulder, and of course the foot?

Very provocative article, Dr Alexander. Thanks for posting.

 

Acting as an lawyer of the devil , another difference between the developed and undeveloped world might be the bacterial life in our mouths or skin for that part. This has to do with our sugar rich food and us brushing our teeth twice or more a day. What if bacterial life is so off balance in favor of the bacteria of interest that the chance of getting them in your blood stream is higher?

I feel TMS is largely responsible for chronic pain still. Even if the thing stated in the article is true, I still believe a stress-less person is much more capable of getting rid of any bacteria.

 

If stress can depress the operation of the autonomic nervous system and produce TMS, it certainly sounds as though stress is equally capable of depressing the operation of the autoimmune system and thus reducing resistance to disease-bearing bacteria. Perhaps the two processes go hand-in-hand? Haven't a clue about how the autonomic and autoimmune systems interact. Does anyone?

 

This is rather worrying if as you say, Dr A, only a small percentage of back pain sufferers might respond positively to anti-biotic treatment. Once the story is really out there, the majority of back pain sufferers may be rushing to their GPs and requesting a prescription. Is it preferable to surgery? The UK's chief medical officer might not agree. I don't wish to be a scaremonger or worry anyone unnecessarily but when I read your post and your blog, I recalled this article I had read not too long ago:​

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Professor Dame Sally Davies, the UK's chief medical officer has raised an alarm that increasing cases of antibiotic resistance pose a "catastrophic" threat to public safety comparable to the threat of global terrorism.​

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She said the problem is a "ticking time bomb" that could lead to a situation in which patients undergoing minor surgical procedures are exposed to grave risks because effective antibiotics are not available to protect them from infections.​

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Read more: http://digitaljournal.com/article/345368#ixzz2TBs2LHlh​

 

I talked with a TMS doctor about this article and he suggest waiting to see if this study gets replicated.

 

I have a 'hunch', Endless, that the bacteria are able to get into the soft tissues in the lower lumbar region because of depressed autoimmunity that occurs in conjunction with the changes in the autonomic nervous system associated with TMS. This would also explain why rigorous physical activity can lessen TMS pain because then more white cells are pumped into the affected areas where they combat the low-grade infection. Of course, it could also be because during rigorous exercise more oxygen also gets into those tissues, thereby reducing the TMS pain, just as Dr Sarno hypothesizes. I get a feeling that repressing your emotions not only adversely affects the autonomic nervous system but autoimmunity as well. I suppose Dr Schubiner's grant to study mind-body interactions might well end up casting some new peer-reviewed double-blind light on this. But as you suggest, it would be best if we all waited to have this Danish study replicated before going on a 100-day antibiotic regime. Actually, that sounds like a real 'vacation in hell' with all kinds of weird side-effects thrown in for good measure.

 

Just a couple of thoughts. I am a little sceptical. I do believe stress can have a pronounced effect of the immune system. The study appears to be a prospective double blinded study which gives it more credibility but there was only follow up at a year and so it is unclear if the improvement is long lasting. If at 5 years, they maintained their improvement that would be better evidence that antibiotics have a role in the management of chronic back pain. I would hope that after 3 months of antibiotics the improvement would be long lasting. I did not have access to what the end points were and what the measures were. Does anyone know if the looked at function, pain, medication use or "cure"?
I remember another bacteria that was all the rage several years ago. It is called H.Pylori and was associated with ulcers. Don't see this all that much anymore. Sound familiar?

 

all good points that people have raised here- its excellent to toss this research finding around a bit. I think many years of research in psychneuroimmunology would support the notion that chronic emotional stress (constant activation of the autonomic nervous system) leads to excessive levels of cortisol release, which damages the functioning of the immune system- making a person more susceptible to infection. It will be interesting to see how the relationship between infections and chronic pain pans out over the next few years. It is likely that once the finding gets out there, people will be demanding anti-biotic treatment as a matter of course (rather than subject themselves to lumbar punctures to assess for the bacteria), anti-biotics will become even more prescribed, and we will be careening even faster to super-bugs which can wreak havoc. Of course, clear parallels to stomach ulcers and H.Pylori.

 

Antibiotics can have anti-inflammatory effects - perhaps this can account for improvements?

 

I'd say: Test don't guess. If they don't have the bacteria in their spine, don't give them any antibiotics.