The causes of lower back pain are varied, sometimes vague and often complex. And according to two studies published in the European Spine Journal, in as many as 40% of cases of persistent lower back pain, the condition may be caused or exacerbated by a bacterial infection that can be cleared up with a three-month course of antibiotics.
According to lead researcher Hanne B. Albert Ph.D., of the Spine Center of Southern Denmark, the study showed an association between long-term back pain caused by a herniated (or slipped) disk and infection with Propioni bacterium acnes, a bacterium commonly found deep in hair follicles in the mouth that plays a role in acne. When a disk herniates or ruptures, the bacteria can gain entry to the otherwise maximum security-like structure of the lumbar spine (lower back)
In a web chat and news conference, Dr. Albert explained the significance of the findings and clarified the types of lower back pain that can be treated with antibiotics.
Dr. Albert pointed out that the treatment won’t work for everyone. It’s for patients shown to have had a previous herniation and existing microfractures of the vertebrae (known as Modic changes) via MRI. In addition, they have severe pain that persists at night and worsens with exercise.
A Decade of Research
Dr. Albert said the research started in 2001. In a study of 61 patients who had spinal surgery for lower back pain, the researchers found bacteria in 46% of the slipped disks.
In a second study, the research team recruited 162 patients who had been living with low back pain for more than six months after a slipped disc. Half of the patients were given a 100-day course of antibiotics, while the others received a placebo. After a one-year follow-up, those who had taken antibiotics were less likely to still have lower back pain and physical disability. They were also less likely to have leg pain and to have missed work because of back problems.
The study has drawn kudos and caveats. Paul Bishop, a spine doctor and researcher at ICORD, a spinal cord injury research center in Vancouver, told the the Globe and Mail that the study’s design has shortcomings. Although the researchers restricted the study to patients with disk degeneration, they did not exclude patients with other potential pain generators, including arthritis.
All agree that the study is promising but that more research needs to be done.