Researchers in Denmark have demonstrated a link between many cases of long-term back pain and infection by acne bacteria. One leading British expert described the find as “the stuff of Nobel prizes”.
Trial evidence indicates that pills to treat infection rather than surgery can bring an end to constant, lower back pain.
In the first of two papers published in the European Spine Journal, researchers showed how bacteria invading the injury sites of slipped discs caused painful inflammation and damage to vertebrae.
Infection was previously thought to play only a small role in back pain, but nearly half the slipped disc patients tested positive for bacterial infection.
The vast majority of infections were caused by Propionbacterium acnes, the bug responsible for acne. It secretes an acid capable of dissolving bone, leading to bone swelling. It may be to blame for up to 40% of all cases of chronic lower back pain, the researchers believe.
The second study tested a new form of treatment based on the discovery.
A group of 162 patients who had suffered from chronic back pain for more than six months following a slipped disc, and had signs of bone swelling, were either given a course of antibiotics or placebos.
The antibiotic treatment proved effective in 80% of cases, leading to significant reductions in pain.
In their paper, the scientists, led by Dr Hanne Albert of the University of Southern Denmark, wrote: “Antibiotics should be considered as a treatment option for this special subgroup of patients with chronic low back pain.”
Neurosurgeon and spinal expert Peter Hamlyn, from University College London hospital, said: “The discoveries... require us to reconsider our understanding of chronic low back pain. One of the commonest causes of disability in our communities, lost working days, and ongoing pain, chronic low back pain is an international plague. More work needs to be done, but make no mistake this is a turning a point.. It is the stuff of Nobel prizes.”
But Professor Laura Piddock of the University of Birmingham, stressed that antibiotics should only be used in cases where a bacterial cause of pain had been identified.