Back Pain & Antibiotics

Back Pain & Antibiotics May Provide Relief Where Other Methods Fail

Studies have suggested that as much as 40 percent of chronic back pain sufferers may be infected with bacteria which might be treatable using antibiotics. Back pain & antibiotics is a combination that may provide relief for sufferers that have had no success with other treatments.

Back Pain & Antibiotics – What Causes The Pain?

The back pain results from a specific type of degenerative spinal changes called Modic Changes Type I which is only visible with MRI imaging. Antibiotics have been used to target a anaerobic (does not like oxygen) bacteria called Propionibacterium acnes, which has been seen in 43 percent of patients that have undergone surgical procedures for disc herniation in the lumbar spine. Bone swelling or edema, indicative of Modic changes, particularly type I, was found in the spinal bones of 80 percent of lumbar discs which were infected with the bacteria.

Modic changes are found 6 times more in those suffering chronic low back pain than in the average population and in some instances, bacterial infection was related. Traditional therapies used in the treatment of back pain such as exercise, manipulation and injections are not effective for those who suffer from Modic Type I changes. This is for Type I only – there are three types.

Is Treating Back Pain & Antibiotics For Me?

If a response is Yes to three or more of the following questions, it is possible that your pain could be related to Modic changes in the spine and antibiotics could help.

  1. Is there pain in the lower back during the night?
  2. When turning over in bed, does the pain in the lower back wake you up?
  3. Is the pain worse in the morning, better at noon and worse again in the afternoon and evening?
  4. Does it feel as though the pain is located deep in the back?
  5. Does the pain sometimes radiate down to one or both legs?
  6. Does the back pain get worse or stay the same when doing physical activity or exercising?
  7. Have x-rays ever shown some disc degeneration?
  8. Is the back pain constant or changes very little most of the day, making it difficult to ignore the pain?
  9. Have treatments that normally help back pain not work?

Modic change refers to a pathological and structural change within the vertebral bone. The condition is named after Dr Michael Modic, who identified these findings in 1988, which can be readily be identified through specific MRI scans called T2.

What Does The Scientific Studies Say About Back Pain & Antibiotics?

Scientific studies on Modic changes have shown that there is a correlation between having Modic type I changes in spinal vertebrae and suffering back pain. Studies have also indicated that patients with Modic changes have more severe pain than patients with “normal” back pain caused by usual spinal conditions and muscular strains, where the bone tissue remains normal.

75-80% of patients with Modic changes suffer from constant back pain. The intensity of the pain may vary during the day in relation to physical activity, but it never goes away completely. 68% of people identified with Modic changes are so afflicted with pain at night that when they turn over in their sleep they are woken up due to back pain.

back pain & antibiotics

What Does It Treat?

Normal bone consists of tiny threads of bone and the spaces between these threads are filled with red bone marrow, which produces blood cells. In Modic change Type I, many of the tiny threads are fractured, resulting in an uneven bone structure. Instead of healthy red bone marrow, the spaces between the threads consist of a clear liquid, similar to that found in a blister and new nerve fibers that transmit pain grow into the bone.

If commonly used treatments have not brought relief, it is possible that the back pain is caused by Modic changes in the vertebrae. Conventional back pain treatments including injections, exercises, spinal manipulation and other not helpful in those with Modic Type I changes. The latest research shows that back pain due to Modic I changes can be successfully treated with a prolonged course of antibiotics.

Is It Safe?

Antibiotics should not be taken lightly and careful scrutiny is needed to identify those who are most likely to benefit from antibiotics for treatment. A MAST (Modic Antibiotic Spinal Therapy) center has a certified Modic antibiotic therapy spinal doctor and/or therapist can review your medical history and MRI scans. A thorough physical examination is performed where the classical signs relating to Modic changes can be identified. Thorough patient information is crucial as Modic changes are a result of a complicated disease process and in the different stages of recovery appropriate advice is needed.

Possible side effects must be managed carefully. A MAST Academy certified doctor and/or therapist will ensure that optimal results are obtained and can transform your life into a relatively pain free status. As a relatively new for of treatment, there are not many certified practitioners and you may have to ask your doctor or therapist about certification or reviewing the evidence regarding Modic changes and back pain and working with a qualified expert on antibiotics for back pain that can answer your questions.

A study of 61 patients found a highly significant association between presence of the anaerobic bacteria in nuclear tissue of discs and Modic change. The researchers said that this discovery merited the establishment of a new disease category: Modic related low back pain. In another study, researchers found that a long course of antibiotic treatment was more effective than placebo in patients with chronic low back pain associated with vertebral bone edema. The study involved 162 patients who had chronic back pain of longer than six months after a previous disc herniation and who had Modic type I changes in the vertebrae that could be seen on magnetic resonance imaging.


The patients were receive either 100 days of antibiotic treatment with amoxicillin with clavulanic acid or placebo (a pill without antibiotics, unknown to the subject). Four patients stopped treatment, mainly because of gastrointestinal side effects. The researchers found that 80% of patients who received the antibiotics were significantly better able to function after one year, had less lower back pain, less leg pain, and fewer days off work than patients in the placebo group.

Propionibaterium acnes normally live in hair follicles, in acne, or on the gums, but the bacteria can pass into the blood stream through teeth brushing. They usually pose no threat as they circulate around the body, but when a person has a herniated disc and degenerative changes the body grows fresh blood vessels that reach into the soft disc to repair the tissue. This gives the bacteria a way into the disc. As the bacteria grow they cause inflammation around the disc and release propionic acid, a chemical which can irritate nerves.

Peter Hamlyn, a consultant neurological and spinal surgeon at the University College London, indicated, “It’s a paradigm shift in the way we view and treat chronic low back pain – in the same way as the discovery of Helicobacter pylori brought about a shift in how we treat ulcers. We will have to rewrite the textbooks.” Hanne Albert at the University of Southern Denmark and Hamlyn are board members of the MAST – Modic Antibiotics Spinal Therapy medical academy, which promotes information and training for health professionals and patients in Modic change and chronic lower back pain.

Hamlyn added that getting patients to comply with 100 days of antibiotic treatment may be a problem. “It won’t be suitable for everyone with chronic lower back pain, but for those severe cases which show up positive on an MRI [magnetic resonance imaging] scan then it is a lot better alternative than carrying out a big operation. We need to change practice now”.

In a 2021 critical review in the Spine Journal, the authors indicate “…for certain subsets of patients, the reduction in pain and disability achieved with antibiotic therapy may be significant. In patients for whom other therapies have failed, and who might otherwise progress to disc replacement or fusion surgery, antibiotic therapy may well be an attractive option to reduce the individual suffering associated with this debilitating condition.”

Author Bio

Stephen Ornstein, D.C. has treated thousands of neck, shoulder and back conditions since graduating Sherman Chiropractic College in 1987 and during his involvement in Martial Arts. He holds certifications as a Peer Review Consultant from New York Chiropractic College, Physiological Therapeutics from National Chiropractic College, Modic Antibiotic Spinal Therapy from Dr. Hanne Albert, PT., MPH., Ph.D., Myofascial Release Techniques from Logan Chiropractic College, and learned Active Release Technique from the founder, P. Michael Leahy, DC, ART, CCSP.