The Korean Journal of Pain
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26(04) 327-335
Should We Start Treating Chronic Low Back Pain with Antibiotics Rather than with Pain Medications?
Christof Birkenmaier, MD
Department of Orthopaedics, Ludwig-Maximilian-University Munich, Grosshadern Campus, Munich, Germany
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
For those of us who have read the 2 recently published articles by a Danish − British research group, it might appear that we are observing an impending paradigm shift on the origins of chronic low back pain. The results of this research indicate, that chronic low back pain associated with bone marrow edema in vertebral endplates that are adjacent to herniated intervertebral discs may be caused by infections with anaerobic bacteria of low virulence. According to these articles, treatment with certain antibiotics is significantly more effective than placebo against this low back pain. If these findings are to hold true in repeat studies by other researchers, they stand to fundamentally change our concepts of low back pain, degenerative disc disease and in con-sequence the suitable therapies for these entities. It may in fact require pain specialists to become familiarized with the details of antibiotic treatments and their specific risks in order to be able to properly counsel their patients. While this seems hard to believe at first glance, bacteria have been implicated in the pathogenesis of other conditions that do not primarily impose as infectious diseases such as gastric ulcers. While the authors refer to a few previous studies pointing into the same direction, the relevant research is really only from one group of collaborating scientists. Therefore, before we start prescribing antibiotics for chronic low back pain, it is imperative that other researchers in different institutions confirm these results. (Korean J Pain 2013; 26: 327-335)
The Korean Journal of Pain 2013 Oct; 26(04) 327-335
Keyword : antibiotics, discitis, low back pain, Modic changes, Propionibacterium acnes.

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