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The role of antibiotics in chronic low back pain:- Recent advancements

Until recently it was thought that infections played a only a small role in rare causes of chronic low back pain until research from Denmark concluded that between 20% and 40% may be caused by infections (Sample, 2013). In their studies they used long term antibiotics treatment and found that there was a highly significantly reduction in back pain symptoms after treatment and at 1 year follow up (Albert et al, 2013).

Who does this apply to?
The study is aimed at a small subgroup of patients who have had back pain more than 6 months and who have had an MRI scan to confirm that there are signs of disc herniation and bone inflammation.

How long did patients have to take the medication?
All patients who received the antibiotics took them for a total of 100 days. This is due to the fact that the area has a low blood supply.

Why is this important?
Until now doctors thought that infections play only a small role in the cause of back pain and this research suggests that this sub group seem to benefit from a course of antibiotics rather than having surgery (Brukner, 2013)

Conclusions
This potentially revolutionary finding may help a sub group of back pain patients. The cost of these medications are far less than the traditional option of surgery. However as with all scientific findings more research is planned to establish the exact dosage, duration and type of antibiotic needed.

How does it affect me?
If you have had back pain for more than 6 months and have had an MRI with findings suggesting inflammation, doctors may now be able to treat your back pain with long term antibiotic medication. However it is a subject still under debate and is by no means a widely used treatment. Further studies are needed before the issue changes medical opinion.

Contributing Author
Alex Huntly – Physiotherapist BSc (Hons) MSc (Sports Med)

References

Albert HB, Sorensen JS, Christensen BH, Manniche C. (2013). Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy.. Available: http://www.ncbi.nlm.nih.gov/pubmed/?term=Antibiotic+treatment+in+patients+with+chronic+low+back+pain+and+vertebral+
bone+edema+%28Modic+type+1+changes%29%3A+a+double-blind+randomized+clinical+controlle. Last accessed 03/05/14

Brukner, P. (2013). @PeterBrukner discusses today's major headline: Successful antibiotic treatment in a subset of people with chronic low back pain. Available: http://blogs.bmj.com/bjsm/category/low-back-pain/. Last accessed 03/05/14

Sample, I. (2013). Antibiotics could cure 40% of chronic back pain patients. Available: http://www.theguardian.com/society/2013/may/07/antibiotics-cure-back-pain-patients. Last accessed 03/05/14