Can Antibiotics Cure Chronic Back Pain?

A recent article in the European Spine Journal reports that up to 40% of patients with a history of chronic back pain from a herniated disc may find improvement with long term antibiotic therapy.  A double blinded, randomized controlled study evaluated 166 patients with a history of chronic low back pain greater than 6 months in duration and evidence of a disc herniation on spinal imaging.  Bacteria, specifically Proprione acne bacteria, which normally lives in hair follicles and the mouth, was found inside affected discs.  Patients were randomized to receive either a 100 day antibiotic treatment regimen or placebo.  Patients who were placed on the antibiotic regimen were noted to have statistically significant improvement in back and leg pain, whereas the placebo group did not note significant improvement.

While there may be a potential role that bacteria plays in chronic low back pain, use of antibiotic therapy should be used judiciously and appropriately.  Healthcare professionals and patients should strongly consider the potential adverse consequences of chronic antibiotic use, such as developing resistant strains of bacteria and superimposed infections such as C. dificile infections.  Further research, including a focus on safety and side effects of such treatment, would be recommended prior to advising such treatment for the general community.