What’s the number one chief complaint of all time? Two words: back pain. And that’s not specific to patients with cancer. In fact, lots of patients carry diagnoses of both cancer and back pain that aren’t necessarily related. So maybe we should keep amoxicillin in our back pocket. Ok, that all makes sense. Except… huh? When did we start talking about amoxicillin? When this randomized trial comparing amoxicillin to placebo for chronic low back pain was published this week causing all the buzz on twitter. And not because it worked; because it didn’t. People are hating on what they see as voodoo medicine. But, to be fair, the background sounds pretty solid. The key inclusion criteria was the presence of disc herniation and vertebral endplate changes—aka “Modic changes” named after, you guessed it, Dr. Modic—with a well-founded (in another phase 3 trial) hypothesis that such anatomy makes a nice home for smoldering infections. Sure, three months of antibiotics isn’t benign, but most chronic back pain remains a huge unsolved riddle. TBL: Perhaps we shouldn’t be so fast to shower authors of negative trials with hate-orade lest we throw fuel on the fire of publication bias. | Bråten, BMJ 2019


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