Could millions of Americans finally find relief for chronic lower back pain simply through a cheap course of antibiotics? That's the shocking takeaway from two studies appearing in the recent issue of 'European Spine Journal.' Doctors caution, however, that this possibly revolutionary approach, although promising, needs further vetting. "When you get something that's pretty radical – and this is radical – you want to make sure it's correct and proper before applying it to patients," says Dr. Jeffrey Fischgrund, professor of orthopedic surgery at Oakland University at William Beaumont Hospital in Royal Oak, Michigan, who was not involved in the studies.
The research, out of Denmark, focused on the approximately 40 percent of lower back pain sufferers with herniated (slipped) disks as well as spinal bone swelling as seen in magnetic resonance imaging (MRI) scans. Researchers speculated infections might trigger the inflammation. In the first study, 43 percent of herniated disk surgery patients turned out to have Propionibacterium acnes in their spines; 80 percent of these infected patients also developed bone swelling. The bacterium P. acnes resides in hair follicles and gums and circulates in blood. New blood vessels sprouting into slipped disks in an attempt to heal them let the opportunistic bacteria set up shop, the study authors theorized. The second study gauged if antibiotics could help. Patients with MRI-documented bone swelling (though not direct biopsies to confirm infections) received either a 100-day, $180 antibiotic course or placebo; 80 percent on the former reported feeling much better one year later.
The findings made quite the media splash. Many stories in the United Kingdom quoted neurosurgeon Peter Hamlyn, who was not involved in the studies, saying that the researchers "deserved a Nobel prize." Most outlets overlooked that Hamlyn and lead author Hanne Albert set up a website promoting the study's therapy, suggesting of a financial conflict of interest.
These issues aside, the results could nevertheless be "groundbreaking," Fischgrund said, pending repetition by outside scientists. "The big 'but' is that this needs to be replicated," agrees Dr. Edgar Ross, director of the Pain Management Center at Brigham and Women's Hospital in Chestnut Hill, Massachusetts. "It's a bit too early to call this a breakthrough," he said, like the paradigm shift in the late 1990s tying stomach ulcers to bacteria instead of stress or diet.
The study authors in no way recommend putting everyone with chronic lower back pain on long-term antibiotics, which carry risks of diarrhea and breeding resistant "superbugs." Still, desperate back pain victims might think the hazards worth it; Fischgrund notes his practice has fielded around a dozen antibiotic treatment inquiries since the studies' news broke in May. Given the number of people plagued by lower back pain, expect much more interest. "About 90 percent of Americans in the fourth decade of life and beyond will have back pain," said Ross. "It's an enormous problem."
Until further research, experts suggest you exhaust all options before taking antibiotics. That includes getting physical therapy, a new ergonomic chair, losing weight, and strengthening your core muscles. If nothing else works, you can get tested for Propionibacterium acnes, by biopsy – in other words, getting a needle in the back rather than indiscriminately taking antibiotics.
Related: Five Ways to Prevent Back Pain