What do some forms of chronic low back pain and acne have in common? A recent headline-grabbing study claims that as many as 80% of chronic low back pain sufferers are actually suffering from an infection of the intervertebral discs caused by the same bacteria that cause acne.1
Does this mean everyone with chronic low back pain should ask their doctor for antibiotics? Not so fast, experts warn; but, they add, this study was well designed and should not be dismissed. Researchers have uncovered an area of spine health that needs to be investigated further.
Herniated discs could open the door to infection
The study was conducted to shed more light on a previous herniated disc study that showed significant amounts of Proprione acne bacteria (the same bacteria that causes acne) in the intervertebral disc tissue of patients with a herniated disc.2
After a disc herniates, tiny blood capillaries grow into the disc to nourish and heal the injury. The increased blood flow has the unintended effect of introducing the Proprione acne bacteria, which is commonly found in hair follicles and in the gums, into the disc space. The introduction of the bacteria results in a chronic infection, resulting in pain and bone edema (swelling).
Studying the role of antibiotics to treat chronic low back pain
To further this research, scientists in Denmark recruited 162 patients with a history of a herniated disc. The patients also had chronic low back pain and bone edema (swelling)-known as Modic Type 1- for at least six months. Bone edema was confirmed with several MRI scans.
The trial was double blinded and randomized. Patients received 100 days of antibiotic treatment with amoxicillin clavulanate tablets three times a day, or 100 days of an identical placebo. The patients were evaluated 100 days after starting treatment and again after one year.
Researchers focused on evaluating disease-specific back pain and disability using the Roland Morris Disability questionnaire (RMDQ). The questionnaire asks 23 yes/no questions that focus on the impact back pain has on the participants' quality of life and daily activities.
Researchers concluded that the antibiotic group demonstrated statistically significant improvement among the primary and secondary outcomes, and they continued to improve from the 100 day mark until the one year mark.
- Less disease-specific disability
- Less lower back pain
- Less leg pain
- Fewer hours with pain in the last 4 weeks
- Fewer sick days
Using the self-reporting scale, the researchers noted that 80% of the patients on the antibiotics had significantly less low back pain. The placebo group showed no improvement in any of the measured outcomes.
The scope of this study is narrow, since only patients with a confirmed herniated disc and chronic pain were included. Larger studies with more diverse populations are needed to determine the role of antibiotics for treating low back pain.
- Albert HB, Sorensen JS, Christensen BS, Manniche C. "Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy," European Spine Journal, published online April 2013, accessed March 15,2013.
- Hanne B. Albert, Peter Lambert, Jess Rollason, et al. "Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?" European Spine Journal, published online April 2013, accessed March 15, 2013.