Are Bacterial Infections Causing Back Pain?
Written by Editor   
Thursday, May 14, 2015 12:00 AM

The results of several exciting and controversial studies on the use of antibiotics for treating low-back pain have recently been reported in the media. Other studies point to the presence of bacteria (propionibacterium acnes) in the disc and surrounding tissues in many patients with low-back pain. These studies show that as many as 40 percent of those with low-back pain may have a low-grade infection of the disc and end plates, causing the pain.

The findings of bacteria in tissues and the response to antibiotic therapy appear to be strongly associated with changes which are visualized on MRI.  They have long been considered an inflammatory response to mechanical injury and are six times more prevalent in people with chronic low-back pain than in the general population. 

If these preliminary studies are found to be accurate and substantiated by additional randomized controlled studies, it will be highly disruptive to the current models of care for low-back pain like the researchers who received the Nobel Prize in 2005 for discovering that the bacteria helicobacter pylori was responsible for peptic ulcers. Those who adamantly and publicly ridiculed the early research on helicobacter pylori were left looking a little foolish.

These are certainly some exciting studies, and like many studies that sound promising in the newsstand, they may not bear the scrutiny of further research. Here are a couple of other possible explanations for the findings in these studies:  Many antibiotics have an anti-inflammatory effect, and we may be seeing the results of this anti-inflammatory effect. I am more skeptical about the bacteria causing back pain than I am about antibiotics relieving back pain.  The tissue samples that contained the bacteria could have been contaminated in handling. It should be noted that propionibacterium acnes is a common contaminant in pathology samples.

What is not clear is whether the bacteria arrive in the low back first and are the source of the changes or if a back injury occurs resulting in bony edema and then this region of slowmoving blood allows bacteria from the blood to establish a foothold and grow.

Some “early adopters” in medicine are not waiting for further research. They have created clinics and certification in Modic Antibiotic Spinal Therapy (MAST). MAST treatments currently utilize a 100-day course of antibiotic treatment. This prolonged course of antibiotic treatment caused several of the research subjects to drop out of the study because of side effects (e.g., diarrhea and gut pain).

These studies on the use of antibiotics to treat back pain are certainly sensational and have the potential to change the way we treat low-back pain. They have the appearance of being well-documented, well-written science, and while these concepts are far from being scientifically confirmed, they also cannot be ignored. This research is compelling science, but it is not conclusive.