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This house believes that in 2014 antibiotics should be used to treat certain specific types of chronic back pain. Philip Sell. What we have. Archie Cochrane. CONFOUNDING FACTORS. The Evidence. Level one Single study Quality of evidence Consort Grade.

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This house believes that in 2014 antibiotics should be used to treat certain specific types of chronic back pain

Philip Sell

the evidence
The Evidence
  • Level one Single study
  • Quality of evidence
    • Consort
    • Grade
why the unease
Why the unease ?
  • Why is it some have no doubts
  • Why is it some have massive doubts?
the reason we are uncomfortable
The reason we are uncomfortable

DAILY EXPRESS

Miracle cure for back pain: Agony ended by everyday antibiotics

CHEAP antibiotics could end the agony of back pain for millions of Britons for ever.

press reports before peer acceptance
Press reports before peer acceptance
  • MMR studies
  • Steroids in cord injury
  • Hence our doubts
need for a science based approach
Need for a science-based approach
  • Rigorous theory and methods
  • Fully specify interventions and mechanisms
  • How much evidence is needed
intervention was right theory was wrong
Intervention was right; theory was wrong
  • The logic of hand-washing with chlorine was right (the technical intervention worked)
  • But the big theory of resorption of cadaveric particles was wrong
  • And the adaptive work was disaster
original article magnetic resonance imaging in follow up assessment of sciatica

Original ArticleMagnetic Resonance Imaging in Follow-up Assessment of Sciatica

Abdelilah el Barzouhi, M.D., Carmen L.A.M. Vleggeert-Lankamp, M.D., Ph.D., Geert J.Lycklama à Nijeholt, M.D., Ph.D., Bas F. Van der Kallen, M.D., Wilbert B. van den Hout, Ph.D., Wilco C.H. Jacobs, Ph.D., Bart W. Koes, Ph.D., Wilco C. Peul, M.D., Ph.D.,for the Leiden–The Hague Spine Intervention Prognostic Study Group

N Engl J Med

Volume 368

March 14, 2013

N Engl J Med

Volume 368

March 14, 2013

conclusion
Conclusion
  • MRI performed at 1-year follow-up in patients who had been diagnosed with sciatica and a herniated disc on MRI …… did not distinguish between those with a favorable outcome and those with an unfavorable outcome
back pain s association with vertebral endplate signal changes in sciatica

Back pain’s association with vertebral endplate signal changes in sciatica

Abdelilah el Barzouhi, M.D., Carmen L.A.M. Vleggeert-Lankamp, M.D., Ph.D., Bas F. Van der Kallen, M.D., Geert J.Lycklama à Nijeholt, M.D., Ph.D.,Wilbert B. van den Hout, Ph.D., Wilco C.H. Jacobs, Ph.D., Bart W. Koes, Ph.D., Wilco C. Peul, M.D., Ph.D.,for the Leiden–The Hague Spine Intervention Prognostic Study Group

Eurospine 2013

slide26

Backpain diminishes over time

Evolution of back pain in surgicallytreated

patientsaccordingto VESC

Evolution of back pain in conservatively

treatedpatientsaccordingto VESC

the trial
The Trial
  • Unusual Control group show no change
  • Trial recruitment
  • Not spontaneous presentation
  • Trial entry Invite to attend to 347 patients known to the organisation. 162 recruited
harmless1
Harmless?
  • MMR
  • Poor uptake of vaccines
  • Measles epidemic in Wales
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This house believes that in 2014 antibiotics should be used to treat certain specific types of chronic back pain

MORE STUDY REQUIRED

BE OPEN MINDED

REJECT THE MOTION