Scientists at the University of Southern Denmark say, “Maybe.” New research indicates that 20 to 40 percent of all chronic, lower back pain is caused by bacterial infection and that treating this infection with an extended course of antibiotics can help many patients avoid back surgery.
As a physician who cares for patients with chronic low back pain, I am thrilled about this news! Although surgery is necessary and effective for some patients; far too often, we see patients who still suffer from chronic, low back pain even after undergoing surgery. Learning that a bacterial infection may be the culprit in some of these cases gives us a very promising treatment option to explore.
The results of the Denmark research, which was conducted over a period of 10 years, were reported in two papers published in the peer-reviewed European Spine Journal. The first paper explained how a bacterial infection within a slipped disc causes painful inflammation and small fractures in nearby vertebrae. According to the scientists, when a person suffers a slipped disk, the body grows small blood vessels into the disk to promote healing. But when the microbe commonly associated with acne, “propionibacterium acnes,” is present in that person’s bloodstream, it can get ferried into the disc, causing inflammation in that disc and the surrounding area.
In their second paper, the researchers showed that a 100-day course of the antibiotic “amoxicillin clavulanate” could alleviate chronic, low-back back pain. This double-blind, randomized control trial included 162 individuals, some of whom took the antibiotic, and some of whom took a placebo. Using the Roland-Morris Disability Questionnaire (PDF) to rate their back-pain levels, the group who took the antibiotic reported that their pain dropped from “15” to “11.5” after 100 days, and further improved to “7” after one year. These results stand in sharp contrast to the placebo group, who, after 100 days reported that on average their pain levels fell from “15” to “14.” After 1 year, the placebo group remained at “14.”
It’s important to note that this study did not include people suffering with acute or sub-acute back pain – only those suffering from long-term, lower back pain that lasted six months or longer. Furthermore, all of the participants underwent MRI scans that proved that they had damaged vertebra. Although additional research is needed to investigate whether individuals suffering from any other kinds of back pain might benefit from taking a course of antibiotics, we now have another tool to help at least some patients obtain pain relief without undergoing surgery.
Of course, we must be mindful that the long-term use of antibiotics can cause other health issues, such as digestive problems and nutritional deficiencies. Therefore, if you consider this treatment, be sure to ask your physician about the possibility of taking probiotics and nutritional supplements to mitigate possible side effects.
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