The study looked at 162 men and women who had low back pain for at least six months. They all also had a history of herniated lumbar discs along with Modic type-1 changes on their MRI scans. About 6% of the general population has Modic type-1 changes. But, in those with low back pain, the number is more like 35-40%. These patients are often the worst cases. For example, close to 80% of patients suffering from Modic changes have constant pain. They never get a break. The pain might be more or less at times, but it is always there.

Well, you'll never guess what the researchers gave these patients for therapy.

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They gave half of them an antibiotic (Bioclavid) every day for 100 days. The other half took a placebo. Before the experiment started, they were all examined for their level of disability, back pain, leg pain, number of days on sick leave, and MRI findings. Both groups had similar findings at the beginning of the study. Then they re-examined the participants after the 100 days and again after one year. The results are surprising.

According to the authors, "The antibiotic group improved highly statistically significantly on all outcome measures and improvement continued from 100 days follow-up until one-year follow-up."

In terms of disability, the placebo group remained the same whereas the antibiotic group had a greater than 50% reduction. Low back pain was cut in half for the antibiotic group, but was unchanged for the placebo.

For leg pain, the antibiotic group had a 73% reduction, while the placebo group was the same. The antibiotic group also showed improvement on sick days and MRI findings. And here's the thing. The researchers gave some of the patients higher doses of the antibiotic. And they found that the higher the dose was, the better the results were. Clearly the antibiotic was working. But why? The answer might surprise you.

The surprising answer is that previous studies have shown that anywhere from 50% to 73% of herniated lumbar discs are infected. That's amazing! Who would have guessed? How do they get infected? No one knows. But there are indications that the Modic type-1 changes on MRI scans are there because of underlying infections.

What's clear is that antibiotics can be a powerful solution for treating back pain. The negative is that they do have side effects. They destroy your gut bacteria, which can lead to other health problems. Fortunately, there's a better solution that works in a similar way. I'll tell you about it on Friday.

Yours for better health,

Frank Shallenberger, MD

REF: 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 Apr;22(4):697-707.