Should We Start Treating Chronic Low Back Pain with Antibiotics Rather than with Pain Medications?

Abstract

For those of us who have read the 2 recently published articles by a Danish - British research group, it might appear that we are observing an impending paradigm shift on the origins of chronic low back pain. The results of this research indicate, that chronic low back pain associated with bone marrow edema in vertebral endplates that are adjacent to herniated intervertebral discs may be caused by infections with anaerobic bacteria of low virulence. According to these articles, treatment with certain antibiotics is significantly more effective than placebo against this low back pain. If these findings are to hold true in repeat studies by other researchers, they stand to fundamentally change our concepts of low back pain, degenerative disc disease and in consequence the suitable therapies for these entities. It may in fact require pain specialists to become familiarized with the details of antibiotic treatments and their specific risks in order to be able to properly counsel their patients. While this seems hard to believe at first glance, bacteria have been implicated in the pathogenesis of other conditions that do not primarily impose as infectious diseases such as gastric ulcers. While the authors refer to a few previous studies pointing into the same direction, the relevant research is really only from one group of collaborating scientists. Therefore, before we start prescribing antibiotics for chronic low back pain, it is imperative that other researchers in different institutions confirm these results.

Pedicle screw-rod fixation: a feasible treatment for dogs with severe degenerative lumbosacral stenosis

“…This could also be the case in our study, as five dogs were treated for discospondylitis conservatively with antibiotics prior to the collection of disc material for bacterial culture. Interestingly, the topic of bacteria in IVDs causing low back pain has received considerable attention in recent years in the field of spine research in humans and has since been the subject of heated debate [ 47 – 49 ]. This debate was initiated by reports by Albert et al [ 50 ] on findings of bacteria in IVD material harvested during spinal surgery [ 51 ] and publication of a randomized clinical trial showing successful treatment of humans with chronic low back pain using long term oral antibiotics [ 52 ].…”

Is IL-1β Further Evidence for the Role of Propionibacterium acnes in Degenerative Disc Disease? Lessons From the Study of the Inflammatory Skin Condition Acne Vulgaris

“…The seminal, potentially paradigm-shifting study that first provided evidence to link P. acnes infection of the degenerated disc to CLBP was published by Stirling et al ( 2001 ). Since then, the role of this bacterium in CLBP has received considerable attention, as well as controversy, due to the possibility of novel treatment options for this debilitating condition (Birkenmaier, 2013 ). Subsequent independent research into this exciting area has been collectively examined in two independent meta-analyses published in 2015.…”

What is the Role of the Bacterium Propionibacterium acnes in Type 1 Modic Changes? A Review of the Literature

“…In addition, it is possible that low-virulent P. acnes is prevalent but often overlooked because it is considered normal flora or a possible contamination, and it could require several days to get a positive culture. Further, it should be considered that if a correlation between P. acnes in the disc space and MC1 is found in some patients but not all, it could be a result of variation in immune response [30].…”