The role of antibiotics in the treatment of chronic back pain

There has recently been much media interest in two recent papers written by Albert and Colleagues and published in the European Spine Journal.  

Researchers looked at patients having chronic or longstanding low back pain and the possibility that they may have infected disc material.  These patients also demonstrated what is known as Type I modic changes, which is essentially bone inflammation within the spine and can be seen on a MRI scan.

It is suggested that those patients with modic Type I changes would respond to 100 days of antibiotics and in the second paper the drugs reduced the pain in 80% of patients who had MRI changes and suffered pain for more than 6 months.  

The issues for those of us in physical therapy relate to the use of MRI scans for those patients who do not respond well to physical therapy and where modic Type I changes are seen.  This applies to patients suffering back pain for more than 6 months.  Here at Parry and Gilmour we will refer them on to a Spinal Surgeon or Pain Specialist to determine whether they are suitable for antibiotic treatment. 

It is important to remember that further treatment is not suitable for all patients and the use of long term antibiotics is not without problems of risk of side effect and intolerance.  It is also important to know that, whilst the research does look promising, the numbers of patients within the trials are relatively small.  However, more trials are needed to investigate this type of treatment further.