2016 Top Doctor in 5280 Magazine
Back pain is one of the most common issues affecting our society. Low back pain is the fifth leading cause for office visits in the US, and at least a quarter of Americans report having back pain for at least one day in the last three months (1). Interestingly we don’t know exactly what causes back pain. The treatment of chronic back pain is one of the most difficult issues facing spine surgeons. Recently there has been interesting developments in this area. Investigators in Denmark discovered that micro-bacterial infection of the disc material (the cushion in between the vertebrae as seen in the picture)
can be associated with increasing degenerative changes in the spine (2). Another study from the same group looked at 162 adults with low back pain for more the six months with bone edema in the vertebrae adjacent to a disc herniation (such changes occur in 35-40% of those with back pain). Those patients were randomly assigned to receive either a course of antibiotics or placebo. It was found that a course of antibiotics is significantly better then placebo at treating the back pain (3).This is a fascinating discovery and indeed may lead to other significant advances in identifying the cause of low back pain. Is chronic low back pain a result of an indwelling bacterial infection? Is it possibly a result of the immune system reacting to the infection? It is possible that this discovery will lead to improved treatment and prevention of one of the most common causes of disability. However, as with anything one must exercise caution with all such discoveries. This is only the first such study showing the benefit of antibiotic treatment in back pain. Antibiotic treatment does have side effects, not the least of which is the creation of resistant bacteria which is currently a big problem in hospitals. Not all patients who have back pain should go on antibiotic treatment. However, back pain that lasted more then 6 months and is accompanied by Mobic type 1 changes (edema in the vertebrae adjacent to a disc herniation) should probably be treated with antibiotics prior to consideration of major surgery.
As always in Advanced Brain & Spine we seek to treat neurological conditions such as back pain but first and formost we would like to prevent those conditions from occuring in the first place and as such I thought it’s appropriate to mention that fitness programs and staying active can help improve function and prevent back pain from becoming chronic (4).
1. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from US national surveys. Spine 31:2724-7, 2006.
2. Albert HB, Lambert P, Rollason J, Sorensen JS et al. Does nuclear tissue infected with bacteria following disc herniation lead to Modic changes in the adjacent vertebrae?. Eur Spine Journal 22(4):690-696, 2013.
3. Albert H, 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 Journal 22(4): 697-707, 2013.
4. Krismer M, van Tulder M: Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). Best Pract Res Clin Rheumatol, 21:77-91, 2007.
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