Take Two Antibiotics and Call Your Back Doctor in the Morning

05/13/2013 07:52 EDT | Updated 07/13/2013 05:12 EDT

At one time or another, most of us will experience a sense of discomfort in the lower back . It can be acute, lasting only a few days to weeks, or chronic, lasting months or years. Depending on the severity, it could be little more than an annoyance or a completely debilitating condition. Medical professionals have been working for over 80 years to identify the causes of this ailment and find ways to improve the lives of those who suffer because of it. Most research has focused on physiological associations, but over the last few decades, other causes have been identified including cancer, changes in immune function, and diet.

Now there appears to be another culprit in the development of lower back pain: acne.

The main bacterium involved in the formation of acne is Proprionibacterium acnes; it is known for causing those unsightly bumps on the skin. Yet researchers have learned that the bacteria can also be found inside the body and over time spread internally where it can grow and cause chronic problems such as heart disease, brain abscesses, and prostate cancer. In 2005, P. acnes was found to be associated with chronic lower back pain after routine back surgery. This intriguing result started a search for the bacteria in other medical conditions, and soon sciatica and spinal disc inflammation were also added to the list.

With this information in hand, in 2008, a team out of the University of Southern Denmark led by Dr. Hanne B. Albert decided to take the infection angle as a given and treat a small group of lower back pain sufferers with antibiotics. The results were quite surprising: Over 60% of the patients showed improvement in their condition. The treatment also appeared to have long term effects, as there was no relapse of the condition after 14 months. The results suggested that bacterial infection might play a larger role than expected, and the team put together a clinical trial to determine the potential for this route of treatment.

Now, five years later, the answers from that trial are finally being revealed in a landmark paper in the European Spine Journal. The team investigated whether the use of antibiotics would either improve or cure the condition. A separate group of 90 individuals out of 162 were given antibiotics and then investigated for improvement in lower back pain after one year. There was a significant improvement in back pain in over half of those given antibiotics and of them, 30% no longer suffered after one year. In comparison, a control group, who received a placebo, saw minimal improvement and only a 6% resolution of all back pain complaints. While the results were not as impressive as expected, the use of antibiotics was helpful in the majority of cases.

Both studies by Dr. Albert offer hope that a new direction in lower back pain treatment may be possible. However, this does not mean that everyone who suffers from this ailment needs to be treated with medication. In almost all instances, the diagnosis of lower back pain had to be made after an MRI test; these were long term sufferers with literally no other options. In addition, 45% of those enlisted had undergone some form of lumbar surgery, which could have allowed the bacteria to enter the spinal cord. Yet despite these limitations, there was little doubt that antibiotics were effective.

There is definitely enough evidence to suggest medical professionals may soon have one more weapon in their arsenal against chronic lower back pain. However, the path towards antibiotic use may not be as easy as making a routine visit to the general practitioner as it is with other ailments. We currently live in an era of antimicrobial resistance and there is a push towards the use of less antibiotics -- and even then, only when needed. This stewardship is based on a number of thresholds that have to be met before an antibiotic is prescribed.

Thanks to the work of Dr. Albert, these criteria, including long-term ailment with little sign of improvement, prior MRI examination, medical history of surgery, and the presence of face and body acne, are now known. For those who have met these criteria, there may be benefit to using antibiotics -- and probiotics to prevent a transfer from lower back pain to lower intestinal diarrheal distress. For those who have yet to reach this brink of burden, more traditional routes are recommended, including heat and/or ice, anti-inflammatories, and, of course, rest.

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