NEWS AND VIEWS
Year : 2014 | Volume
: 5 | Issue : 1 | Page : 71-
Antibiotics to end the curse of low back ache
|How to cite this article:|
. Antibiotics to end the curse of low back ache.J Pharmacol Pharmacother 2014;5:71-71
|How to cite this URL:|
. Antibiotics to end the curse of low back ache. J Pharmacol Pharmacother [serial online] 2014 [cited 2020 Sep 26 ];5:71-71
Available from: http://www.jpharmacol.com/text.asp?2014/5/1/71/124431
Hundreds of thousands of people with the chronic low back pain (LBP) could be cured by antibiotics according to ground-breaking research that one expert said deserved a Nobel Prize. The discovery that infections cause up to 40% of cases of LBP has prompted calls for an overhaul of treatment to avoid unnecessary surgery. 
Before furthering on the above news it is pertinent to know certain terms related to the same. They are "Modic changes" Types 1-3. Based on magnetic resonance image (MRI) studies Modic et al. reported three types of changes in degenerative disk disease ranging from bone marrow edema and inflammation through marrow ischemia to subchondral bony sclerosis. 
Modic type 1 changes in the vertebrae though seen in 6% of the general population, about 35-40% of the LBP population have such changes, which has been strongly associated with LBP. In a ground breaking double-blind RCT involving patients with chronic LBP (with Modic type 1 changes in the vertebrae adjacent to the previous disc herniation) 100 days of antibiotic (amoxicillin + clavulanic acid) was compared with placebo. The improvement in the antibiotic group was highly statistically significant, which continued until 1-year follow-up. The primary outcomes were disease-specific disability, lumbar pain while the secondary outcomes were leg pain, number of hours with pain in the last 4 weeks, global perceived health, days with sick leave, bothersomeness, constant pain.  It is the belief of the researchers that infection by anaerobic microorganism Propionibacterium, which produces acid that corrodes the spine, causing fresh and excruciating pain.
The same lead author group has reported the usefulness of antibiotic treatment for LBP in a previous pilot study around 5 years earlier  during which time they hypothesized that bacterial infection may play a role in LBP. 
Treatment with antibiotic for LBP has already been termed as Modic antibiotic spine therapy protocol. 
Two points, as food for thought:
Since the organism being anaerobic, why not an anaerobic-effective drug (e.g. Metronidazole) be added to the treatment regimen.
The focus of infection being the spine, would it be better to administer the drugs parenterally to achieve a better drug concentration, at least during the initial period of treatment?
|1||Available from: http://www.theaustralian.com.au/news/world antibiotics-could-end-curse-of-lower-back-pain-say-researchers/story-fnb64oi6-1226637440700. [Last accessed on 2013 May 12].|
|2||Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: Assessment of changes in vertebral body marrow with MR imaging. Radiology 1988;166:193-9.|
|3||Albert HB, Sorensen JS, Christensen BS, Manniche C. 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. Eur Spine J 2013;22:697-707.|
|4||Albert HB, Manniche C, Sorensen JS, Deleuran BW. Antibiotic treatment in patients with low-back pain associated with Modic changes Type 1 (bone oedema): A pilot study. Br J Sports Med 2008;42:969-73.|
|5||Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C. Modic changes, possible causes and relation to low back pain. Med Hypotheses 2008;70:361-8.|
|6||Available from: http://www.medscape.com/viewarticle/803858 [Last accessed on 2013 May 13].|