For nearly half of all chronic back pain sufferers, s simple course of antibiotics may cure about 40% of patients with chronic back pain, researchers from the University of Southern Denmark and the University of Birmingham, England, reported in the European Spine Journal. Neurologists are describing this breakthrough as “the stuff of Nobel Prizes”.

The scientists demonstrated an association between long-term back pain and infection with Propionibacterium acnes, a bacterium commonly found on human skin that is involved in causing acne.

According to trial evidence, administering antibiotics to clear infection may bring an end to the constant lower back pain and all the misery that comes with it – offering a simpler, better and much cheaper option than surgery.

If the results of the trial can be confirmed in larger studies, millions of people around the world who suffer from long-term back pain could experience a complete change in quality of life.

The Mayo Clinic estimates that approximately 80% of all Americans will have low back pain at least once in their lives, and a significant proportion of these people develop chronic back pain. Back pain is the most common reason for absence from work in the USA.

According to the National Health Service, UK, approximately four million people in the United Kingdom suffer from chronic back pain.

Two studies have been published in the European Spine Journal. In the first study, Hanne B. Albert PT., MPH., Ph.D., from The Back Research Centre, University of Southern Denmark, and team demonstrated how bacteria invade the injury sites of slipped discs and cause painful inflammation, as well as harming surrounding vertebrae.

Experts had previously believed that if bacterial infections played a role in back pain, it was probably only a minor one. However, this trial showed that nearly half of all the patients with slipped discs tested positive for bacterial infection, and mostly by the acne-causing bacterium Propionibacterium acnes.

Dr. Albert and colleagues believe the bacterium is probably the cause of up to 40% of all cases of long-term back pain.

In the second study, the same researchers tried out an antibiotic combination treatment based on their discovery. They recruited 162 volunteers, all of them chronic back pain sufferers. They defined “chronic” as somebody whose back pain has lasted for more than six months. All of the participants had had a slipped disk and had signs of bone swelling.

The patients were divided into two groups:
  • The antibiotic group – they were administered Amoxicillin (amoxicillan) and clavulanate for 100 days

  • The placebo group – they received an inactive placebo (dummy drug)
The antibiotic treatment proved effective in 80% of cases. The authors wrote that patients experienced significant reductions in disability and pain.

Dr. Albert wrote:

“Antibiotics should be considered as a treatment option for this special subgroup of patients with chronic low back pain (CLBD).

More confirmatory work in other populations and studies on improved protocols as well as the background science should be encouraged.”

The Daily Telegraph quoted Dr. Peter Hamlyn, an expert neurosurgeon from University College London hospital, who said:

“Make no mistake this is a turning point, a point where we will have to re-write the textbooks. It is the stuff of Nobel prizes.”

Nursing Times quoted Professor Laura Piddock, from the University of Birmingham, England, who cautioned that antibiotics should only be considered for chronic lower back pain if a bacterial cause has been identified. Inappropriate use of antibiotics can contribute to the proliferation of resistant bacteria.

Professor Piddock said “For this reason, physicians are encouraged to liaise with their consultant microbiologist colleagues for the most appropriate tests to carry out.”

Written by Christian Nordqvist