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Antibiotics could cure chronic back pain, study finds

Antibiotics could cure 40pc of chronic back pain patients

By , Health Correspondent

Up to four in 10 cases of chronic lower back pain could be cured by antibiotics, research has suggested.

Around five million people in Britain will suffer chronic back pain at some point in their lives, and the cause is often not clear.

The research by the University of Southern Denmark found that almost half of cases of chronic lower back pain could in fact be caused by bacteria.

Of those, most were cured or significantly improved by one three-month dose of antibiotics – at a cost of just £114 per patient – the study found.

Currently, the NHS spends more than £1 billion a year on treatment of back pain, while patients spend at least £600 million a year on private healthcare and alternative remedies.
The Danish studies, published in the European Spinal Journal, found the presence of bacteria in 46 per cent of patients suffering from chronic lower back pain following a slipped or herniated disc.

Researchers suggested that the problems occur because when a disc becomes herniated, bacteria can enter and cause an infection – causing bone swelling and persistent pain.

Their second study of 162 patients found that when such cases were given the antibiotic combination amoxicillan and clavulanate, 80 per cent were cured or saw a significant reduction in their pain levels.

Peter Hamlyn, a consultant neurologist and spinal surgeon at University College London hospital said the discoveries were so significant that in future, half of all patients who would otherwise endure spinal surgery might instead be helped by antibiotics.

While more research was required to confirm the findings, he said the discovery appeared to be a major breakthrough in tackling one of the most common causes of disability.

He said: “Make no mistake this is a turning point, a point where we will have to re-write the textbooks,” he said. “It is the stuff of Nobel prizes.”

It has long been known that it is possible for infections to cause back pain, but these cases had been thought to be rare.

Dr Hanne Albert, of the Danish research team, said the findings could give patients who suffer constant pain “a form of normality they would never have expected.”
Experts likened the findings to a breakthrough thirty years ago, when the bacteria Helicopter pylori was found to be the cause of gastritis and stomach ulcers, radically changing the way they were treated.

John O’Dowd, President of the British Society for Back Pain Research, said: “It is a very striking study, and those behind it are a very high calibre group of scientists. This is definitely something we need to take seriously but the results are very surprising and this is an area where there is a great deal of uncertainty.”

He said more studies needed to be carried out to replicate the findings before the NHS changed its advice.

“I wouldn’t want to see a great rush to market this as the best response to chronic lower back pain until that has been done,” he said.

Prof Laura Piddock, Professor of Microbiology from the University of Birmingham said antibiotics should only be used to treat back pain once a bacterial cause had been identified.

Otherwise far too many people could be “needlessly” exposed to the drugs, she said, increasing their likelihood of becoming resistant to them, and at risk of future infections.
Prof Piddock, deputy director of The Institute of Microbiology and Infection, said doctors needed to liaise with microbiologists to ensure specific tests were carried out before antibiotics were prescribed for back pain.

A spokesman for the National Institute for Health and Care Excellence, which recommends which treatments are funded by the NHS, said the research would be considered next time its guidelines on back pain are reviewed.

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Dysthymia – due to lack of serotonin

Sitting in a Cardiff cafe, chatting and laughing with one of her friends, it’s hard to believe Meryl Cubley has spent most of the past two decades in a bad mood.

She herself thought that ‘negative feelings, a lack of energy and having little enthusiasm for life were my personality’.

But four months ago, Meryl, now 38, was diagnosed with dysthymia — a little known yet common condition characterised by chronically low mood and energy, sleep and appetite problems as well as an aversion to social contact.

Meryl is now having treatment that is already transforming her life.
‘I’ve stopped cancelling engagements at the last minute and am seeing friends more regularly,’ she says.

She is also sleeping better and has lost weight.
And, perhaps most importantly, she says: ‘For the first time in years I am feeling better in my day-to-day life.’
The ‘old’ Meryl is a type we all recognise — the grumpy, glass-half-empty person who’s always in a bad mood.

We tend to dismiss them as naturally negative but, according to research, these cynical types deserve more sympathy because they are actually suffering from a form of depression linked to hormone imbalances.

As many as 3  per cent of the population is thought to be affected, but because they tend to cope with the demands of everyday life and work — something those with major depression usually struggle with — they can go untreated and undiagnosed for decades, even their whole life.

‘Sufferers are often unaware of a problem and see it as who they are,’ says Professor Craig Jackson, head of psychology at Birmingham City University.
‘This can begin to shape their personality and outlook on life, so they respond to life’s setbacks and knocks in a more negative fashion.

‘This deepens their low mood — so dysthymia can become a vicious circle that’s hard to break.’

Meryl’s case was typical. One study in the Journal of Clinical Psychiatry found that sufferers of dysthymia typically live with the illness for up to 30 years, and only half seek treatment.

Despite a successful career as a novelist and being in a stable relationship with her partner Richard, a housing officer, Meryl never felt a sense of enjoyment from life.
She was 19 and at university when she was first overcome by feelings of anxiety and hopelessness.

Her GP diagnosed depressive anxiety and prescribed beta blockers, but these ‘dampened my mood and made me feel numb and uninterested in everyday life’.
She was then prescribed an antidepressant, but this just made her more anxious, so she stopped taking it.

‘Also, I didn’t really believe I had depression to be honest.
‘I knew I felt down most days, was irritable and negative, but I never had a problem getting up and out. I thought it was part of who I was, and resigned myself to always feeling this way.’

Guidelines issued two years ago by the National Institute of Health and Clinical Excellence (NICE) say that for a diagnosis of dysthymia patients should have had any two symptoms of depression for at least two years. (For depression, they need to have had at least three symptoms for just two weeks.)

Such symptoms include feeling sad for more days than not, low energy, a low appetite or overeating, sleeping too much or too little, a negative outlook on life, withdrawing from social contact and experiencing little joy in everyday life.

‘People with dysthymia usually only experience one or two of these symptoms — but they usually have symptoms for longer,’ explains Dr Cosmo Hallstrom, a consultant psychiatrist and spokesperson for the Royal College of Psychiatrists.
As for cause, a combination of social, biological and psychological factors may be to blame, suggests Professor Jackson.

‘We often see dysthymia run in families,’ he says.
‘But though we don’t know if there is a genetic link, a child brought up by two chronically pessimistic parents, or where either parent have what psychologists call a “negative affectivity” (a pervasive nature to err on the more gloomy side), can be deeply impacted at a subconscious level.’

Dr Hallstrom adds: ‘Rather than being a symptom of dysthymia, chronic cynicism may, in fact, be a cause of it.
‘If you are raised or work in an environment where cynicism is pervasive, that can lead to dysthymia because it means constantly being critical, which can lead to the chronic negative outlook in someone with dysthymia.’

Dysthymia is linked to a lack of serotonin — a brain chemical that governs mood, he says.
Recent studies have found it may be caused by an imbalance of dopamine, another brain chemical.

‘We need a certain level of brain chemicals such as dopamine and serotonin to function well, and people that produce too little — or, in some cases, too much, thus upsetting this delicate balance — may experience symptoms of dysthymia,’ says Professor Jackson.

Typically, dysthymia symptoms begin in late teens or early adulthood, says Professor Paul Keedwell, a consultant psychiatrist at Cardiff University and author of How Sadness Survived: An Evolutionary Basis for Depression.
The problem often goes untreated because GPs don’t know enough to spot it, adds Dr Hallstrom.

‘For every one person with a depressive illness, there are up to three not diagnosed.
‘People with dysthymia will often fall into this group, because they will be functioning and may think nothing can be done.’
But left untreated, people with dysthymia are at higher risk of a major depressive illness.

According to research published in the journal Psychopharmacology Bulletin, 75 per cent of those with dysthymia will have at least one episode of full blown depression, and many will have more than one.

Many people will need to go through a major depressive episode where they stop functioning before they realise something is wrong and seek help, says Dr Hallstrom.
Meryl suffered five bouts of major depression.
‘During these times I would see my doctor and he would try me on yet another antidepressant,’ she says.

‘But they would either make me hyperactive and more irritable, or tired during the day.
‘Nothing worked, and I would stop taking them after a couple of weeks because of the side-effects and leave each episode to pass of its own accord.’
Between these bouts, Meryl ‘still wasn’t what you would call happy — I was low and irritable on most days.

‘I’d stay in whole weekends and not go out; or organise to meet friends and then feel down and cancel at the last minute.’
She was finally diagnosed last summer after she saw a new GP.
‘This new doctor asked specific questions about my symptoms — how I rated my everyday mood, how many hours I slept most nights, how my appetite was, and about my social life,’ says Meryl.

‘He explained that in between my depressive episodes, he believed I was suffering with dysthymia.
‘It was the first I had heard of it, but all the symptoms described me. It was a huge relief.’
According to Professor Keedwell, antidepressants such as serotonin reuptake inhibitors may work in some cases by regulating levels of serotonin and dopamine.
But generally the evidence for their effectiveness for dysthymia is weak. By contrast, the evidence for talking therapies such as Cognitive Behavioural Therapy (CBT) is strong, he says.

Stressolim, which is designed to naturally rebalance neurotransmitters in the brain, has a positive effect on Serotonin and dopamine levels, and therefore enhances mood.

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Doctors are reporting a rise in the number of people suffering from gastrointestinal problems.

Issues such as erratic eating patterns, stress from hectic lifestyles, more processed food and “excess hygiene in childhood, lowering gut immunity” being seen as major factors.

Recent research has found that stomach ache, bloating and cramps are on the increase, despite people with such problems trying to be more careful over what they eat.

Experts have warned that measures to try to ease the problem could actually be making them worse.

Advice to add bran to cereals to help with constipation has now been found to exacerbate some forms of constipation, and jacket potatoes, often seen as a healthy option as they are low fat and a good source of vitamins B, B6 and C and fibre, can lead to problems because of the fillings like butter and mayonnaise which are added.

Dr Anton Emmanuel, consultant gastroenterologist at London’s University College Hospital, said: “I often see patients who are unwittingly making their tummy symptoms worse.”

Honey can also cause digestive issues because it contains a lot of fructose which is not well absorbed into the gut and while salads and sandwiches may appear healthy the fat in mayonnaise and salad cream can upset the stomach.

Other foods experts say to be aware of include mild curries, onions, coffee and chocolate.

Chocolate can lead to stomach cramps, heartburn and bloating while coffee acts like a laxative, by increasing contraction in the small and large intestinal muscles.

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Love your gut bugs

Biologists are shining a scientific spotlight on previously neglected inhabitants of our bodies. The 100tn bacteria that populate an average adult, living mainly in the guts, should be treated with more respect, recent research shows, because they play a vital role in maintaining human health.

The latest study by Chinese scientists provides new evidence that the different types of microbes in the gut can help to explain why some people grow fat and others don’t. The microbiome, as it is known, turns out to be a risk factor for obesity, alongside eating too much, exercising too little and having the wrong genes. Our digestion has evolved to work with the help of a kilogramme or so of microbes; the way we extract calories from food and how fast our appetite is satisfied – determinants of how much weight we put on – depend on the balance between the 200 to 300 bacterial species that live in a typical human gut.

As several recent studies have shown, this balance depends critically on what we eat. People living on a modern western diet have a very different microbiome from their pre-industrial ancestors. And a study of elderly people in Ireland, published in the journal Nature this summer, showed a direct relationship between diet, bacterial diversity and wellbeing. Although more research is needed to prove the point, evidence is growing that a varied diet, including plenty of unprocessed fruit, vegetables and cereals, promotes the growth of beneficial bacteria in the human body – indicating another possible theme for public health campaigns.

At the same time scientists at Reading University and elsewhere are taking a more directed approach. They are designing and testing “prebiotic” dietary ingredients to select for a beneficial community of gut bugs that reduces the risk of obesity and associated problems such as diabetes.

Appreciation of the importance of nourishing a healthy human microbiome should also lend weight to a quite different public health campaign: the drive to cut over-prescribing of antibiotics for trivial or inappropriate infections. Although antibiotics are intended only to kill pathogens, there is collateral damage to other microbes, upsetting the bacterial balance.

The message for the holiday period, as you eat your festive foods, is to remember that you are feeding not just yourself but all the bugs in your body. Treat them to a varied diet – and do not poison them with unnecessary medication.

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Gut bacteria balance may affect your appetite

Over the last half decade, it has become increasingly clear that the normal gastrointestinal (GI) bacteria play a variety of very important roles in the biology of human and animals. Now Vic Norris of the University of Rouen, France, and coauthors propose yet another role for GI bacteria: that they exert some control over their hosts’ appetites. Their review was published online ahead of print in the Journal of Bacteriology.

This hypothesis is based in large part on observations of the number of roles bacteria are already known to play in host biology, as well as their relationship to the host system. “Bacteria both recognize and synthesize neuroendocrine hormones,” Norris et al. write. “This has led to the hypothesis that microbes within the gut comprise a community that forms a microbial organ interfacing with the mammalian nervous system that innervates the gastrointestinal tract.” (That nervous system innervating the GI tract is called the “enteric nervous system.” It contains roughly half a billion neurons, compared with 85 billion neurons in the central nervous system.)

“The gut microbiota respond both to both the nutrients consumed by their hosts and to the state of their hosts as signaled by various hormones,” write Norris et al. That communication presumably goes both ways: they also generate compounds that are used for signaling within the human system, “including neurotransmitters such as GABA, amino acids such as tyrosine and tryptophan-which can be converted into the mood-determining molecules, dopamine and serotonin”-and much else, says Norris.

Furthermore, it is becoming increasingly clear that gut bacteria may play a role in diseases such as cancer, metabolic syndrome, and thyroid disease, through their influence on host signaling pathways. They may even influence mood disorders, according to recent, pioneering studies, via actions on dopamine and peptides involved in appetite. The gut bacterium, Campilobacter jejuni, has been implicated in the induction of anxiety in mice, says Norris.

But do the gut flora in fact use their abilities to influence choice of food? The investigators propose a variety of experiments that could help answer this question, including epidemiological studies, and “experiments correlating the presence of particular bacterial metabolites with images of the activity of regions of the brainassociated with appetite and pleasure.”

Source: American Society for Microbiology